Rotator Cuff Tears in Climbers: Do You Really Need Surgery?
Beta-sprayer 1: “oh you have a rotator cuff tear? My uncle had that and he got surgery and now he can’t use his arm at all. I’d just stop climbing if I were you.”
Beta-sprayer 2: “shoulder problems ain’t no thang. Just do more pull ups and bench press and it’ll get better. It worked for me.”
Rock Rehab physical therapist: “let’s look at what the research says, evaluate your shoulder, assess your climbing movement patterns and listen to your entire story. Then we’ll make a decision.”
The Climber's Shoulder Dilemma
If you're a climber dealing with shoulder pain, you're in good company – it's one of the most common issues that can limit your climbing. It affects about two-thirds of adults and ranks among the top three reasons people seek help from medical professionals. For climbers specifically, rotator cuff problems – including impingement, tendon pain, and tears – top the list of likely culprits.
Here's where things get interesting: MRI studies show high rates of rotator cuff damage in both painful AND pain-free climbers. That fancy medical imaging might reveal a "tear," but that doesn't automatically mean you need surgery or should stop climbing.
The Surgery vs. PT Showdown: What Science Says
Ready for some good news? Research consistently shows equivalent long-term outcomes between surgery and physical therapy for rotator cuff tears – even for larger full-thickness tears and traumatic injuries. That's right – the scalpel isn't necessarily your only beta for this problem.
A recent study by Song and colleagues tracked nearly 170 climbers and non-climbers with symptomatic rotator cuff tears. Some received 6-12 weeks of physical therapy focused on rotator cuff and scapular strengthening, while others underwent arthroscopic surgery.
The results? Both groups showed significant improvements with an 80% success rate at the five-year mark. The PT group actually recovered faster initially (at 3 months), while the surgery group showed better results at 6-12 months – but only for those with severe limitations.
When Surgery Might Be Your Best Send Strategy
So who benefits most from going under the knife? The research points to these factors:
You literally can't raise your arm
You've completely dropped out of climbing and other daily activities
You have significant weakness that doesn't improve with PT
You have low expectations that PT will help (mindset matters!)
The Rock Rehab Approach to Rotator Cuff Recovery
At Rock Rehab, we've helped countless climbers overcome rotator cuff issues without surgery. Our approach includes:
Comprehensive Assessment: Determining whether your pain is truly rotator cuff-related or stems from another source like scapular dyskinesis, thoracic spine stiffness, or cervical spine dysfunction (very common in climbers)
Targeted Strengthening: Building strength and stability in both the rotator cuff and the scapular stabilizers – crucial for overhead climbers
Movement Pattern Correction: Identifying and fixing faulty mechanics that might be causing your shoulder to compensate
Climbing-Specific Rehab: Gradually reintroducing climbing movements in a controlled way, rather than generic shoulder exercises
Load Management Strategies: Developing a plan for how much and what type of climbing you can do during recovery
The research suggests giving PT a solid 6-12 week effort before considering more invasive options. This timeline allows for proper healing and adaptation – remember, tendons take time to heal and take even more time to return to full function!
Why You Need a Climbing-Savvy PT
Here's the hard truth: many healthcare providers don't understand climbing. We've seen countless climbers told to "just stop climbing" or given generic rotator cuff exercises that don't address the sport's unique demands.
At Rock Rehab in Santa Fe, our climbing specialists understand the stresses that climbing movements put on our shoulders. Whether it’s a gaston, undercling, lock-off, or mantle, we know how each movement affects your shoulder mechanics and what problems they can cause (and how to fix them!). We know when it's safe for you to get back on the wall and how to modify your climbing to support recovery.
Don't let shoulder pain keep you off the wall indefinitely. Book an appointment with our climbing specialist physical therapists at Rock Rehab in Santa Fe, NM, and let's develop a personalized plan to get you back to sending – with or without surgery.
About the author
With 25+ years of climbing under his harness and nearly a decade as a PT, Evan Ingerson knows what it takes to stay injury-free on and off the wall. Based in Santa Fe, NM, he helps climbers of all levels rehab smarter, train better, and avoid the sketchy advice you heard at the crag. He’s equal parts chalk-dusted dirtbag and science-driven clinician.
