When we think about climbing injuries, the ones that usually come to mind are those that occur on the wall. However, there’s another common climbing-related injury that can happen while watching someone climb – more specifically while belaying. Belayer’s neck is a term climbers use to describe pain and stiffness in the back of the neck that occurs as a result of looking upwards and belaying for long periods of time. The term belayer’s neck isn’t a single diagnosis, but rather a colloquial term used to describe a wide range of conditions that cause the symptoms belayers often experience at the back of their necks.

Signs and Symptoms of Belayer’s Neck:

• Neck pain and/or tenderness

• Muscle spasm and/or stiffness at the back of the neck

• Difficulty or pain associated with looking upwards (extension)

• Difficulty or pain associated with turning your head to the side (rotation)

Causes of Belayer’s Neck: 

1. Muscle Strain - When your neck is tilted backward instead of being centered over your shoulders, the muscles around your neck and upper back must work extremely hard to hold your head against gravity and stabilize it in that position. Holding your head in this position can lead to muscle overuse and strain.

2. Facet Joint Irritation – The cervical vertebrae are stacked on top of each other, like blocks. Between each vertebra is an intervertebral disc which helps to allow movement between the vertebrae, absorb shock, and transmit loads throughout the vertebral column. On the backside of the spine, the vertebrae connect to one another via facet joints (also known as zygapophyseal joints). When your head is in an upright or neutral position, these facet joints have a nice space separating them. When you flex your head (look down), the space between the facet joints increases. When you extend your neck (look up i.e., watching a climber while belaying) the space between these joints decreases, essentially compressing the joints. Over time, these joints can become inflamed, causing pain localized to the neck, and in more severe cases, pain that radiates into your upper back and shoulders.

3. Nerve Root Irritation – A major role of the spine is to house and protect the spinal cord. Between each vertebra, a nerve exits the spinal cord and travels throughout the body to innervate a certain structure (muscles, skin, etc.). Inflammation in the cervical spine interferes with the nerve’s pathway and causes nerve irritation, which the brain ultimately interprets as pain.

4. Thoracic Outlet Syndrome – Thoracic outlet syndrome is a condition that involves entrapment of a specific nerve structure known as the brachial plexus as well as its neighbouring vasculature. This entrapment can occur for a variety of reasons, one of which is muscle tension. When the muscles of the neck become tight and less mobile, they can trap the nerves and vessels that run underneath them. The symptoms of thoracic outlet syndrome differ depending on which structure (nerve, artery, or vein) is entrapped but can include pain, tingling, and weakness in the arm or shoulder, swelling of the arm and hand, and discoloration of the hand and fingers due to reduced blood flow.

What are the risks of Belayer’s Neck?

While some neck pain and stiffness after belaying is normal, and minor symptoms often resolve on their own there are some risks and complications of belayer’s neck that climbers should be aware of. In the short term, belayer’s neck can contribute to unsafe belaying practices which could put both the belayer and the climber at risk of injury. In the long term, unmanaged belayer’s neck can lead to headaches, migraines, muscle imbalances, facet joint inflammations, chronic pain in the neck, shoulders, and upper back, and degenerative changes in the neck (arthritis).

 Luckily, there are a few things you can do to help!

 Prevention and Treatment of Belayer’s Neck:

1. Change where you stand when belaying - Changing the spot on the ground where you are standing will change the angle at which you look up at your partner, which will relieve stressed muscles. Depending on the climb/pitch, this is not always possible.

2. Movement and gentle stretches – During a rest or after a clip, take a moment to gently move your neck out of extension and mix up the position. Changing positions regularly is very important for preventing and relieving neck pain.

3. Rolling – Lie down with a tennis ball or lacrosse ball under the muscles at the base of your skull to help relieve muscle tension.

4. Take breaks – Just like a climber needs to rest between attempts on their project, belayers need to take breaks too!

5. Try belay glasses – These special glasses allow you to stand with your head in a neutral position and still watch your climber as they make their way up their project in the gym or at the crag. Plus, they are very stylish!

6. Massage therapy – A registered massage therapist can help to relieve neck tension and relieve pain following a long day of belaying

7. Physiotherapy – A physiotherapist can provide you with specific neck stretches and strengthening exercises to help relieve and prevent belayer’s neck from occurring. Additionally, they can use manual therapy techniques and modalities such as IMS to help speed up the recovery process.

If neck pain and tightness are preventing you and your climbing partner from having fun climbing sessions and achieving your climbing goals, book an appointment with one of the physiotherapists or registered massage therapists at Elios Health on Main Street in Vancouver, BC. All the practitioners at Elios Health are knowledgeable and experienced in treating musculoskeletal conditions just like belayer’s neck - many of them are climbers themselves and will know exactly how to help get you back to the crag, pain-free! We offer online and in-person assessments at our Vancouver clinic.

Original Post by Rachel Rubin-Sarganis
Photo by Vincent van Zalinge