In February 2016, Black Diamond invited me to be the on-site Physical Therapist for BD Bootcamp, a training program for Black Diamond’s professional climbing team. I spent three days at the Mesa Rim Climbing Training Gym in San Diego, CA, working with BD Athletes Babsi Zangerl, Daila Ojeda and Colette McInerney. My job was to address any injuries that they had before they began their training cycle. As it turned out, each of the ladies had a few, mostly minor, pain complaints that we worked on.

What follows is an article that highlights the most important things I could offer to Babsi to relieve her pain while climbing, hanging and training. Upon examination, we discovered that Babsi was likely dealing with the all-too common and nasty condition of insidious onset biceps tendonitis. First, we needed to dispel the “hang like a bag of rocks on your skeletal system” myth, to explain why “hanging loose” may have led to her shoulder pain, and to address why “hanging right” might help to resolve her current injury and reduce the incident of future misuse injuries.


The question for Babsi, as is vital for the rest of us, was how could we optimize her shoulder position to maintain the health of her joints (and to resolve her pain) while she could still “rest” while hanging. Also, how could we “train” Babsi’s shoulders to be in optimal alignment while conducting off-the-wall exercises, including hang boarding.

Esther working with Babsi for shoulder pain

Image: Jon Glassberg

It’s a myth of climbing beta that we’ve all heard: hanging on your bones instead of engaging muscles conserves energy while resting on a climb. The fallacy of this myth is that the human body is not manufactured to function like a bag of rocks. Hanging loose puts undue stress, wear, and tear on the soft tissues that function to connect the bones in our shoulders, leading to a host of insidious injuries. The wild thing is that climbers are hanging loose even when energy conservation isn’t a concern, such as on the hangboard or pull-up bar.

Healthy muscles are never turned off, and bones cannot function without their soft-tissue counterparts. In effect, hanging loose gives the illusion of rest, while encouraging climbers to position their shoulders in ways that degrade the very t

issues that support their skeleton. By hanging loose we are misusing our joints thereby raising our risk for damage over time.

Babsi reported shoulder pain that developed over a few months prior to BD Bootcamp, with no apparent single event that caused her pain. She reported that certain shoulder motions, exercises and climbing positions caused pain in the front of her shoulder. In a healthy individual like Babsi, with no underlying tissue disorder, and no traumatic event that caused her pain, I concluded that there must have been a mechanism to cause this sort of tissue tweak. Body mechanics topped my list of suspects.

When I watched Babsi climb and train, I saw her hanging slightly “loose” as she rested while climbing at the gym and training on the hangboard. Her upper arms rotated subtly inward while her shoulder blades scrunched slightly toward her ears. She wasn’t using the muscles of her shoulder girdle to optimally position her arm in relation to her shoulder blade, and her shoulder blade with her spine. It became clear that a habitual, almost undetectable, sub-optimal movement pattern led to pinching of the joint space, and irritation of the biceps tendon at her shoulder. Her injury hadn’t been one of overuse; instead this was a misuse injury. The detrimental effects of hanging loose are evident in climbers at all levels, even a wickedly strong and experienced climber like Babsi.

In the process of simply correcting Babsi’s hanging posture at the shoulder, she began to hang, climb and move with less pain. With the addition of a few off-the-wall strengthening and flexibility exercises and some hands-on manual therapy, Babsi’s shoulder pain began to diminish, even while entering into an intense training cycle. As her mechanics improved, so did her climbing – all because she was able to train without pain. Babsi visited my clinic, Grassroots Physical Therapy in Salt Lake City, at the conclusion of her training cycle and reported that her shoulder pain was no longer limiting her while climbing and training. She felt that she had the right tools and strategies to maintain a healthy shoulder and was ready to crush her next project!


To achieve optimal shoulder posture in hanging, we must first establish a solid understanding of what neutral joint positioning of the entire arm is, and what this should look and feel like both while we’re climbing and in everyday activities.

Neutral resting position of the shoulder and arm allows for optimal space between the bony connections of the shoulder joint, and can be described as follows:

A. Tall and lengthened spine with head retracted (ears aligned vertically over shoulders, chin tucked down and back).

B. Shoulder blades settled wide and flush on the back with your muscles slightly engaged so that the front of the shoulders are drawn back (but not pinched together), in vertical alignment with both your hips and your ears.

C. Elbow creases oriented forward (this activates the rotator cuff muscles to rotate the upper arm bone outward and aligns the shoulder joint). Arms at the side.

D. Thumbs oriented forward (in resting, palms or the backs of hands should not be apparent when looking in a mirror).

This posture can be transferred into an engaged position, as in climbing, while arms are overhead as follows:

A. Lie belly down with arms overhead and palms down.

B. Shrug the shoulder blades up and reach with your hands as far overhead as possible, while keeping contact between your hands and the floor.

C. While keeping your palms in contact with the floor, rotate your upper arms outward by turning your elbow creases toward the ceiling.

D. While maintaining that position in you

r arms, gently slide your shoulder blades down your back to the bottom of your available range of motion.

E. Finally, make fists with your hands, and attempt to lift your hands off the ground, while keeping your fists positioned palms-down and your elbows nearly straight.

F. This final position is “hanging right.” You should feel your muscles lightly working to press your shoulder blades securely against your rib cage, while also feeling as though you could hold/squeeze a tennis ball in each armpit (this is the feeling you get when your rotator cuff and scapular sling muscles are engaged).

This engaged posture can also be translated into a hanging position with arms overhead.

Babsi showing hanging position engaged posture

Images: Tommy Chandler

In the incorrect shoulder posture images, the climber is relying on non-contractile tissues (those most vulnerable to poor posture) without using her musculature to stabilize and optimize her shoulder joint’s position.

Using optimal shoulder posture allows this climber’s non-contractile tissues to be the least stressed, and allows her contractile tissues to be in the most optimal functional position. By using incorrect shoulder posturing, this climber is putting her shoulder complex at risk for repeated strain and chronic injury.

As in Babsi’s case, suboptimal posturing of the shoulder is a common contributor to acute and chronic injuries in the shoulder, elbow, wrist, hand and fingers among climbers. It is also the most easily correctable underlying cause of shoulder pain. When we hang loose and don’t engage our shoulder musculature, we may compromise the health of our shoulder joint. The small amount of extra effort it takes to stabilize our shoulder complex with active posturing, and to optimize our alignment, goes a long way in reducing injury and allowing us to climb and train pain-free!

Staying strong, mobile and informed using simple exercises and strategies will keep developing the dynamic sport of climbing that we love, the sport that seems to have no ceiling.

Esther Smith, DPT, Cert. MDT, NTP is a Physical Therapist, a climber and the owner of Grassroots Physical Therapy in Salt Lake City, UT. She is the physical therapist for the Black Diamond Pro Climbing Team and many other climbing ambassadors.

Katey Blumenthal, DPT, MA, is a Physical Therapist, an avid writer, social justice and wellness advocate, who works at Grassroots Physical Therapy in Salt Lake City, UT.