Climbing with Ehlers-Danlos Syndrome: Physical Therapy Approaches

If you're a climber with Ehlers-Danlos Syndrome (EDS), you've likely encountered unique challenges that affect your climbing performance and recovery. EDS is a group of connective tissue disorders that can make your climbing journey different from others. The good news? With proper physical therapy intervention, you can develop strategies to climb safely and effectively despite the condition.

Success with EDS doesn't mean climbing exactly like someone without the condition. Instead, we help you develop your unique approach to climbing that respects your body's needs while maximizing performance.

Understanding Ehlers-Danlos Syndrome

If you have EDS, you're probably all-too-familiar with the symptoms and causes. To review, EDS affects collagen production, a crucial protein that provides strength and elasticity to tissues including skin, joints, and blood vessels. Think of collagen as the natural "glue" that holds your body together—without proper collagen function, tissues become more fragile and joints less stable.

There are 13 subtypes of EDS, but hypermobile EDS (hEDS) is most common among climbers we see at Rock Rehab. This subtype is characterized by joint hypermobility—a quality that often presents as an advantage when you first start climbing. Flexibility is very helpful for many aspects of climbing, but that same flexibility often causes significant problems down the road when you climb more and climb harder grades.

Common Symptoms of EDS

Climbers with EDS typically experience several symptoms that can impact their performance and safety:

• Joint hypermobility (excessive range of motion)

• Joint instability leading to frequent subluxations or dislocations

• Chronic joint and muscle pain

• Skin that bruises easily and heals poorly

• Fatigue and decreased endurance

• Poor proprioception (body awareness in space)

• Slow recovery from minor injuries

• Gastrointestinal issues and autonomic dysfunction

How EDS Affects Your Climbing

EDS creates a paradoxical situation for climbers. While hypermobility might allow you to reach positions others can't, it also puts you at higher risk for injury. Common climbing-specific challenges include:

• Increased risk of finger, shoulder, and knee injuries due to joint laxity

• Difficulty maintaining stable body positions on the wall

• Tendency to overextend joints during dynamic movements

• Greater fatigue and reduced endurance during longer climbing sessions

• Slower recovery between climbing days

• Challenges with grip strength despite flexibility advantages

The most common symptom we see is that climbers with EDS tend to over-crimp. They tend to use a full crimp position for all hold types, rather than varying between open crimping, half crimping, or sloping. This is because full crimping improves the stability of the fingers, but of course it can lead to finger joint pain and flexor tendon injuries.

Physical Therapy Assessment for Climbers with EDS

When you visit Rock Rehab, our assessment for climbers with EDS goes beyond standard evaluations:

• Beighton Score assessment for hypermobility (scoring joint hypermobility at specific sites)

• Comprehensive joint stability testing for climbing-relevant joints

• Assessment of muscle recruitment patterns during climbing-specific movements

• Analysis of climbing technique with attention to joint loading patterns

• Proprioception and kinesthetic awareness evaluation

• Tissue quality assessment

• Functional strength testing in climbing-specific positions

• Movement pattern analysis on and off the wall

Unlike standard medical examinations, our climbing-specific assessment helps identify how EDS affects your unique climbing style and movement patterns.

Physical Therapy Treatment Approach

Our treatment plan for climbers with EDS focuses on five key areas:

1. Joint Protection Strategies

• Education about safe ranges of motion during climbing movements

• Mental and physical techniques/drills to improve muscle activation and joint stability

• Taping techniques to provide extra support for hypermobile joints

• Climbing technique modification to reduce risky joint positions

2. Proprioceptive Training

• Specific exercises to improve your awareness of joint position

• Balance training on progressively unstable surfaces

• Controlled climbing drills with focus on precise movement

3. Targeted Strength Development

• Joint-specific stabilization exercises for frequently used climbing joints

• Core and scapular stability programs to create a solid foundation

• Low-load, high-repetition strength work to build endurance without overstressing tissues

• Isometric training to improve tendon health and joint stability

4. Movement Pattern Retraining

• Analysis and correction of climbing movement patterns

• Development of alternative beta for common climbing problems

• Focus on controlled loading and unloading of joints during climbs

• Technique refinement to minimize injury risk

5. Load Management and Recovery Strategies

• Personalized climbing volume recommendations

• Guidance on appropriate rest periods between sessions

• Recovery techniques specific to EDS-related fatigue

• Progressive return-to-climbing protocols after injuries

The EDS Climbing Journey

As stated previously, success with EDS doesn't mean climbing exactly like someone without the condition. Instead, we help you develop your unique approach to climbing that respects your body's needs while maximizing performance.

Many climbers with EDS find that with proper physical therapy guidance, they can not only continue climbing but excel by leveraging their unique body awareness and developing exceptional technique to compensate for joint instability.

A Long-Term Partnership

Managing EDS as a climber is not a one-time fix but an ongoing process. At Rock Rehab, we build long-term relationships with our EDS climbers, providing support through various phases of your climbing journey.

From dealing with acute injuries to planning training cycles and progressive loading, our physical therapists understand the delicate balance required for climbers with connective tissue disorders.

Ready to develop your personalized climbing approach with EDS? Book an appointment with our climbing-specialized physical therapists at Rock Rehab in Santa Fe, NM who have experience working with hypermobility disorders. We'll help you build a sustainable relationship with climbing that respects your body's unique needs while helping you reach your climbing goals.

Evan Ingerson is a physical therapist based in Santa Fe, NM, with over 25 years of climbing experience and 9 years specializing in treating climbers. He combines clinical expertise with firsthand knowledge of the sport to help climbers recover from injuries, build resilience, and perform at their best. Whether you’re nursing a finger tweak or rebuilding after surgery, Evan creates rehab plans that are as specific and strategic as your climbing goals. Outside the clinic, you’ll find him on the rock, testing his own advice one route at a time.