Common Route Setting Injuries and How to Prevent Them

Route Setter or Industrial Athlete?

Route setting has developed in to a highly demanding career in recent years, as worldwide we have seen an explosion in indoor climbing facilities. According to the Climbing Business Journal,

the number of climbing gyms in the US has consistently increased annually, with 2019 showing 5% growth of the industry in the US. In 2020, 75 more gyms were projected for opening across the United States.

With growth in the number of climbing gyms comes growth in the number of route setters. Routes setters are the individuals responsible for putting holds on the wall in purposeful ways to create new and interesting routes for customers to experience. This job not only involves putting holds on the wall (a task that involves heavy lifting, prolonged work with arms overhead and use of impact drivers), but it also involves lots of rock climbing. In order to produce high quality routes for customers, setters must spend several hours climbing, altering their routes, re-climbing, altering again… on repeat as part of developing a finished product that maximizes customer experience on the wall. The term industrial athlete may be a better fit for this job, as route setters are expected to perform physically demanding manual labor and climb at a high level in order to forerun the routes on the wall which range from beginner to hard and advanced climbing.

Why do route setters get hurt?

Route setting may look like it is all fun and games, but at the end of the day it is a very physically demanding job. Climbers are already prone to certain kinds of injuries due to the nature of the sport and common patterns of strengths and weaknesses associated with the repetitive motions of climbing. Setters develop the same patterns with their climbing and typically exaggerate these strengths and weaknesses due to the physical demands of getting holds and volumes on the wall. The total volume of load on a route setters body includes the hours spent setting, hours spent climbing for work and hours spent climbing for fun outside of work. This load needs to managed appropriately in order to prevent overuse injuries.

Historically, route setters were often individuals and member of the climbing community who either volunteered to set or set a couple of times per month in exchange for free or reduced-price gym memberships. In most cases, this is now a job that belongs to specialized gym employees who consistently work 2-3 days per week as route setters.

Seattle area route setters report an average of route setting two 8 hour days per week, with additional minimum of 1-2 days of climbing outside of work. During periods of preparing for competitions these setters often set and climb for 3-5 (or more) days in a row with minimal rest. This is the total volume that must be considered when assessing risk for injury.

Local Route Setter Screening

Much of the information contained in this post is based on a screening of local route setters in the Seattle area. This screening consisted of a questionnaire regarding history of injuries, as well as a range of motion, strength and motor control assessment completed by a Union PT physical therapist. This information was gathered to better understand common route setting injuries and predisposing patterns of strength and weakness.

Common Route Setter Injuries

Based on the information collected from screening our local route setters, here are some common patterns of injuries reported. This is not exhaustive or listing specific injuries, but focuses instead on common injury sites.

Over 50% of local route setter report:

  • Neck pain
  • Elbow pain
  • Pulley Injury (partial or complete rupture)

Over 70% report recurrent shoulder pain.

Another important finding from this screening is that 50% of setters with multiple injuries reported having these injuries all on one side of their body. Typically, this included having a shoulder injury on the same side of their body as either elbow or finger injuries.

Common patterns of weakness

In addition to asking about history of injury, each route setter was evaluated by a physical therapist to assess for limitations in range of motion, strength and control of their neck and arms.

100% of local route setters demonstrated:

  • Decreased shoulder range of motion
  • Weakness of scapular stability muscles (lower trapezius, middle trapezius, serratus anterior)
  • Weakness of hand muscles with arms overhead

60% of Route setters had weakness of shoulder muscles in overhead positions

Why is this important? Route setters need to be strong with their arms overhead. Weaker hand muscles in overhead positions is often associated with increased risk of pulley injuries. Weak shoulder and scapular stability in overhead positions also predisposes climbers and route setters to injuries in the shoulder, elbow, hand and wrist.

How to prevent route setting injuries

While we can’t prevent every injury, we can help set you up for success. Developing strength in the muscle groups that support the primary muscles used in climbing can help reduce risk of injury. Based on the common patterns of weakness, here are a few ideas for strengthening exercises to supplement route setting, climbing and training:

  1. Doorway latissimus dorsi stretch:
  2. Foam roller pec stretch:
  3. Scapular stability: Y’s and T’s
    1. T’s:
    2. Ys
  4. Internal rotation
    1. Level I:
    2. Level II:
  5. External Rotation
    1. Level I:
    2. Level II:
  6. Serratus Anterior
    1. Level I:
    2. Level II:

If you have experienced a new or recurrent injury related to rock climbing or route setting it is a good idea to be evaluated to ensure an accurate and thorough diagnosis. You can schedule an appointment at Union Physical Therapy in Seattle for an in depth evaluation.

For more information about pulley injuries, please visit this blog post:

About the Author:

Shannon Russell, PT, DPT is a physical therapist at Union PT in Seattle. She was initially drawn to physical therapy after a series of injuries while competing both nationally and internationally in rock climbing competitions. She also has experience as a route setter in the Seattle area. She has a passion for blending her rock climbing background and love for outdoor activities in to her treatment of local athletes and outdoor enthusiasts