Growth plate injuries in youth climbers: do not overlook this injury

Finger InjuriesYouth Climbing InjuriesEpiphyseal Growth Plate Fractures

Oct 20

Quick beta spray:

Growth plate (epiphyseal) fractures are stress injuries to developing bone—unfortunately common in youth climbers who crimp too hard, too often.
Catching it early is critical. These fractures often don’t show up on x-rays until weeks or months after the pain begins. Early examination by a physical therapist can speed up the healing process by months.
Treatment: full rest (not just staying off your project for a few weeks), splinting, and progressive loading under guidance—rushing back too soon can cause significant setbacks.
The alternative to treatment: if left untreated, these fractures lead to severe and permanent finger deformities and stunted growth of the bones in the fingers. Take this seriously! Don’t believe us? Google it. It’s not pretty.

At Rock Rehab, in Santa Fe, New Mexico, we have the rehab protocol dialed for finger growth plate fractures. Do not trust your child’s rehab to a provider that doesn’t understand climbing and doesn’t understand how significant this injury can be if not treated properly.

You’re at the gym and your kid—strong little crusher that they are—says their finger hurts after campusing up a boulder problem or pushing it on the hangboard. No pop, no swelling, just that nagging ache around the middle finger. You think, “probably nothing.” A week later… still hurts.

Welcome to the world of epiphyseal growth plate injuries—the most common finger injury in youth climbers. It’s not a pulley tear. It’s not a strain. It’s the growth plate—the part of the bone that’s literally still growing—getting pissed off from too much load before it’s ready.

What the Heck Is a Growth Plate, Anyway?

An epiphyseal growth plate is a layer of cartilage near the ends of long bones (like the phalanges in your fingers). It’s where new bone tissue forms during growth. Think of it like a construction zone—busy, delicate, and not designed to handle heavy traffic.

In adults, that zone ossifies (turns to bone), but in kids and teens—especially climbers who are going through a growth spurt—those plates are wide open. Every time they pull on a crimp, the flexor tendons yank on the bone right next to that cartilage plate. When the load exceeds what that cartilage can handle, micro-damage occurs. Do it often enough, and you’ve got a Salter-Harris fracture—the technical term for a growth plate injury.

How It Happens

If you hang around the climbing gym, you’ve probably seen the pattern:

A kid gets strong fast.
They start projecting V8+ before they hit puberty. (yeah, kids are strong these days!)
They start hangboarding at 12 because “everyone else is doing it.”
Then one day… finger pain.

Here’s what’s going on under the hood: climbing—especially crimping—creates massive forces across the finger joints. Adult bones and tendons can adapt to this stress, but young climbers’ growth plates can’t yet. The tendons are stronger than the bone, so instead of a tendon injury, the bone fails first—right at the growth plate.

This is why these injuries are often called epiphyseal stress fractures or “growth plate stress reactions.” It’s your body’s way of saying, “Hey, stop trying to pull like Adam Ondra when you’re still growing.”

Diagnosing a Growth Plate Injury

Symptoms can be sneaky:

Deep, achy pain over the dorsal surface (back side) of the PIP joint of the finger (often middle or ring finger).
Pain with crimping, but not necessarily open-hand grip.
Often there is swelling but not always.
Pain lasts days to weeks without improvement.

A good physical therapist or sports medicine doc will start with a clinical exam, palpating along the finger to pinpoint the pain. If the pain’s right over the growth plate line (usually near the middle joint), that’s a red flag.

Imaging is key. X-rays can show widening or irregularity in the growth plate, but early on, they might look normal. MRI is the gold standard for detecting early stress reactions before they turn into full fractures.

Bottom line: if your youth climber has finger pain that doesn’t resolve within a few days of rest—get it checked. The earlier it’s caught, the faster it heals.

Treatment: rest, rehab, and patience

This is where climbers (and their parents) usually groan. Because yes—treatment starts with rest.

Immobilization / Splinting:

The finger is often placed in a neutral or slightly flexed splint (wrist neutral, MCP flexed ~70–90°, PIP/DIP straight) to protect the growth plate while it heals. This lasts around 6 weeks depending on severity.
Gradual Re-Loading:

Once the bone has healed (confirmed by x-ray), a physical therapist (hi 👋) will start gentle range-of-motion and progressive loading—starting with isometrics, then controlled grip work, and eventually climbing drills. The goal is to rebuild tissue tolerance without overloading the healing cartilage.
Addressing the Why:

Most youth climbers with growth plate injuries have some combo of:

Poor load management (too much volume/intensity).
Over-crimping, particularly doing too much full crimping.
Weakness or imbalance in forearm stabilizers.
Limited shoulder or core control leading to excessive finger load.

PT focuses on fixing all that—so the injury doesn’t come right back the second they touch a hold again.
Return to Climbing:

Gradual. Conservative. No full crimps or max hangs until strength symmetry returns and pain stays gone. Think weeks to months, not days. Climbers return to full climbing by 6 weeks at the earliest and pushing it early risks long-term growth plate deformity or early closure.

Prevention: The Real MVP

If you’re a parent, coach, or youth climber, prevention is where you win the long game.

Here’s how:

Skip hard hangboarding until post-puberty

No matter what Instagram says, growth plates need time to ossify. Strength can be built through movement variety, body tension, and good technique. Keep hangboarding to less than body weight and practice all crimp types to dissipate the load on the fingers.
Limit crimping

Train open-hand grip mechanics early. Over-crimping is the fastest way to overload those growth plates.
Watch training load

Pain that lasts more than a few days after climbing isn’t “just soreness.” Track volume and intensity, and schedule rest days like they matter (because they do).
Focus on movement quality, not numbers

Youth climbers who move well and have good technique tend to stay uninjured longer—and catch up in strength later anyway.

The Bottom Line

Growth plate injuries are not career-ending—but they’re serious enough to respect. With early diagnosis, smart rehab, and a solid return-to-climb plan, the vast majority of youth climbers make a full recovery. But the key is recognizing that pain early and not trying to “climb through it.”

Because here’s the truth: your kid’s bones are still building the foundation for all their future sends. Don’t rush the process.

If your young climber has persistent finger pain, get it checked before it turns into something bigger. Schedule an evaluation at Rock Rehab, and we’ll get them back on the wall—safely, and stronger than before.

About the author:

Evan Ingerson has had his fair share of injuries as a national competitor on the USAC youth circuit for 10 years. He is a Santa Fe, NM–based physical therapist and climbing lifer with over 25 years of experience on the wall and 9 years helping climbers get out of pain and back to crushing. He specializes in climbing injuries, return to climbing plans, and calling out bad beta—on routes and in training plans. Whether you’re tweaked, gassed, or just trying to climb smarter, Evan’s here to keep you sending.