How to Climb with hEDS

Disclaimer: This article is not medical advice and I am not a doctor. Please talk to your doctor if you suspect you have hEDS or if you have questions about treatment for your hEDS.

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How does hEDS affect climbing?

Most climbers are familiar with getting injured at some point in their climbing career:  falling off a boulder and spraining an ankle; getting elbow tendonitis from overuse; or popping a pulley on a heinous crimp. It’s common to get sprains, strains, aches, and pains on occasion as a dedicated climber. Now imagine you have a genetic condition that gives you faulty collagen, compromising all of the connective tissues in your body, that makes you far more susceptible to injuries and pain. As climbers with hypermobile Ehlers-Danlos Syndrome (hEDS), this is our reality.

Fallon Trad Climbing
Fallon Rowe (author) projecting 'Habanero' (5.12a R) in St George, UT in 2024. Photo by Charlie Kessner.

For many years as a climber, prior to being diagnosed with hEDS, I wondered what I was doing “wrong.” I had a solid foundation in the sport as a competition climber. I researched climbing training as a coach, athlete, and guide. I prioritized recovery, took rest days, and strength trained to build a resilient body. Yet I was getting injured constantly, battling a revolving door of new injuries no matter what I tried to alleviate the issue. I upped my protein and caloric intake, drank loads of water, dialed in sleep, took more rest days, did my physical therapy exercises, and in general thought I was doing everything “right”… but the injuries kept on coming. The frustration was incomparable. How could my peers train and climb around the clock, eat poorly, party all the time, and never get hurt? Why was I facing new injuries on a weekly or even daily basis despite my best efforts? The confusion and pain made me feel like I must be missing something.

I’ve always been extremely flexible, but I didn’t make the connection that my lifelong problems with my joints, tendons, and chronic pain were due to my hypermobility until I was nearly two decades into my climbing career. Learning that I had hEDS helped everything make sense — why I was struggling so much, why everything hurt more than other people, why recovery took longer for me, why I was predisposed to developing other conditions called POTS and MCAS, and more.

There is a thriving community of paraclimbers with various types of EDS conditions, including hEDS, that has helped me better understand the condition and how it affects climbing. One good resource is @eds_climbers on Instagram, where people can connect and share information.

I want to share what I’ve learned so no other climbers with hEDS feel like they are alone in their challenges. It can be hard to piece together the limited information that exists on social media and in forum posts about climbing with hEDS, so I wanted to create a more centralized resource that can be referenced and shared as needed.

I wrote about my journey with chronic illness, including how I was diagnosed with hEDS, MCAS, and POTS, and the impact those have had on my climbing, at this link. I also spoke about it on the Deliberate Living podcast.

For this article, I got in touch with a couple other climbers with hEDS, Allyson Beach and Caitie McGlashan. Allyson told me that for her, the hardest part about climbing with hEDS is “balancing how far to push [her] body. Every athlete learns the line between pushing to the limits and injury. With hEDS, that line is a bit more fragile.

Caitie said, “On the physical side, I encounter frequent injuries and experience muscular and joint pain on a daily basis. I almost always have multiple minor (sometimes major)  injuries or problem areas. Rather than trying to avoid injuries, I focus on learning how to manage them. Muscle strains, tendinitis and joint subluxations are inevitable when I am trying to push my limits… I must do many hours of physical therapy and strength training. Instead of being sidelined by injury, I modify my workouts (when possible) so that I can continue to train.

What is hEDS?

hEDS stands for hypermobile Ehlers-Danlos Syndrome (thank goodness for the acronym). There are many different types of EDS, and most of them are quite rare. hEDS is the most common by far, accounting for about 90% of EDS cases, and is the kind I have, which is why it’s the focus of this article. (The other subtypes are outside the scope of this article, but if you are a climber with another type of EDS, I’d still love to connect with you and hear about your experiences in climbing!)

eds-spectrum-graphic 1
Image courtesy of

According to the Ehlers-Danlos Society, “hEDS is a heritable connective tissue disorder that causes generalized joint hypermobility, joint instability, and chronic pain. hEDS is also associated with a variety of other symptoms and related conditions that affect many different areas of the body.” It affects the joints, tendons, ligaments, and skin — anywhere you have collagen in your body. The collagen is structurally faulty, making the connective tissues prone to looseness, tearing, and pain. Unfortunately, consuming or supplementing with collagen does not fix the problem because the body will still build the tissues incorrectly.

Graphic showing the Beighton Scoring System
Example of joint hypermobility diagnostic tests that physicians can use to assess patients.

Common symptoms of hEDS (adapted from this site and this site):

  • joint hypermobility
  • loose, unstable joints that dislocate and/or sublux easily
  • joint pain
  • clicking joints
  • extreme tiredness (fatigue)
  • fragile skin that bruises and/or stretches easily
  • digestive problems

Things that can exacerbate hEDS symptoms:

  • overstretching
  • forcing the joints to their extreme end ranges of motion
  • repetitive motions
  • poor diet
  • the menstrual cycle (certain hormones like progesterone increase joint laxity)
  • being stuck in one position for a long time (such as sitting all day on an airplane)
microscopic view of collagen structure
Example of highly magnified normal collagen vs the structurally faulty collagen in a person with EDS.

There is no cure for hEDS since it is genetic and will always be present in the patient. hEDS is commonly comorbid (occurs together) with dysautonomia (such as POTS), irritable bowel syndrome (IBS), temporomandibular joint (TMJ) disorder, mast cell activation (MCAS), sleep disturbances, chronic fatigue, and a host of other conditions. The overlapping symptoms can complicate diagnosis and treatment.

It’s important to note that people can have general hypermobility (such as Hypermobility Spectrum Disorder) meeting some of the Beighton Score criteria for hypermobility, and lack the other symptoms that qualify it as EDS. This can be complex to sort out, so working with a specialist physician is crucial.

Treatment for hEDS prioritizes physical therapy (PT or physiotherapy) for strengthening, stability, and proprioception — learning where your body is in space, and becoming familiar with your appropriate ranges of motion for each joint. PT is essential to help reduce the chance of dislocations and other injuries caused by hypermobility. Strategic taping and bracing of the joints can provide helpful support. Other treatments for hEDS can include occupational therapy, counseling, and pain management options such as medication. In general, staying healthy and active, minimizing stress, and giving the body lots of support is also helpful to keep hEDS and pain well-managed.

To learn more about hEDS, see the bottom of this article for informative links.

Helpful tips for climbing with hEDS

Managing hEDS as a climber and athlete has been challenging. I’ve had countless injuries of varying severity over my 21 years of climbing (and four orthopedic surgeries), and continually deal with chronic pain in many of my joints and tendons. However, climbing is actually a great sport for people with hEDS since it helps the body stay strong and resilient, is relatively low impact, and is easily adaptable with options for terrain, difficulty, etc. Staying active is important to successfully manage the condition, and climbing is a good way to do it! I’ve discovered strategies to keep pushing myself in climbing, and I hope these tactics can help others too.

General tips for climbing and hiking with hEDS:

  • Learn the stable ranges for your joints. Watch videos of yourself climbing to get visual feedback on how you engage your muscles/joints. You can also ask a physical therapist or coach to watch you climb to get feedback on this.
  • If you tend to hyperextend and stretch to your max/end ranges, you will put yourself at greater risk for injury. Though it’s tempting, I usually try not to use my hypermobility to its full extent when climbing — very rarely do I take advantage of my full flexibility since it is more dangerous for my connective tissues.
  • Bringing braces/tape for problematic joints is helpful. For example, I almost always keep a wrist brace and an ankle compression sleeve in my pack since I know those flare up often. I will use KT tape or Euro tape as needed to tape and brace other joints too, especially when crack climbing or dealing with an active injury.
  • Warming up thoroughly with dynamic, gentle movements can help protect your connective tissues. I run through a number of different motions/exercises prior to climbing, often with a Theraband, and then start off with mellow climbing to ease into the session.
  • Limit your number of attempts on the same climb, and your overall climbing volume in a session. Repetitive motions can increase injury risk, so if you try to pull the same crux many times in a row, you’re more likely to get hurt on it. I typically only give projects one or two tries in a session, and then call it. This means I really prepare for every attempt and make it count. I will not try hard/climb at my limit while fatigued because I don’t want to hurt myself.
  • Find the appropriate amount of rest days for you. I find that I need more rest days than my peers. After an easy or regular session, I usually just need one rest day, but after a really hard projecting session or long multipitch, I might need two or three rest days.
  • Listen to your body and be mindful of your pain signals. I try to avoid climbing multiple days in a row. If I must (like on a climbing trip), I make one of the consecutive days very mellow (no hard climbing).
  • Dutifully completing your PT exercises to keep the joints stable and strong will support your climbing success!
  • Remember to take deep breaths while climbing, and really use your rests! If there’s a big jug to hang on or a ledge to stand on, milk it! I will rest and shake out for a long time to give my body a better chance to recover before finishing the climb. Fatigue can make it harder to activate the right muscles and keep your joints in their stable ranges, so staying strong and feeling fresher gives you a better chance to keep your joints in their proper places. If you’re exhausted and climbing sloppy, you’re way more likely to hurt yourself.
  • Stay hydrated, eat well, and get plenty of sleep to set your body up for success and prepare it for climbing. When you feel better overall with fuel, hydration, and rest, it’s easier to stay focused and strong so you can maintain your healthy joint ranges. Consuming plenty of protein is also key for recovery.
  • Double check that you have any needed medications in your backpack (if applicable for pain or otherwise). Caitie mentioned to me that she likes to supplement with magnesium, and sometimes she uses topical magnesium to target specific areas as well.
  • Select climbs to match your energy and symptom level. If you’re having a really symptomatic day, maybe opt for easier climbs rather than a hard project. Sometimes I have managed to climb hard even when symptomatic, so do what feels right for you in the moment. Do what you can, and be gracious with yourself and your performance. Self compassion has been essential in managing my chronic illness and athletic performance.
  • Try not to catastrophize when you feel a new potential injury. I am constantly getting new strains or sprains, and it’s scary to not know if it’s going to be a short-lived issue that resolves in a few days, or a major issue that lasts for weeks or months. That uncertainty is one of the most challenging parts about dealing with hEDS. Take it one day at a time, give yourself support, and consult a PT if you think the injury warrants attention.
    • Keeping a log of pain/new injuries has also helped me so I feel like I have some control over the situation, and data to track in case it ends up being a longer term problem.
  • Limiting stretching or yoga has been crucial for me. I used to stretch all the time and do yoga classes (my climbing teams growing up did this religiously), and it really set me back with my hypermobility and pain. Not stretching or doing yoga anymore has made my body feel so much better, and I am still super flexible regardless. If you’re determined to continue doing yoga or similar activities, work with an expert teacher to find modifications to poses, and don’t push your joints too far.
  • Be cautious with falling, and work on your falling technique — especially while bouldering — to protect your joints.
  • Use a stick clip when sport climbing. Not taking ground falls is nice!
  • Some body work, like massage, scraping, cupping, and so on has been helpful for me (using devices like the ArmAid, the Wave Tool, etc). However, you want to be gentle and not overdo it. I’ve had clients with hEDS who got deep tissue massages that caused major injuries. Remember that your connective tissues need some love and blood flow, but take it easy!
  • Communicate with your partner or group. When they understand your struggles, they can help you more. This also gives me less anxiety about needing to go slow on approaches, asking partners to carry more weight if needed, etc.
Fallon climbing a granite sport route
Fallon Rowe climbing "The Drilling Fields" (onsight) in City of Rocks in 2023 (photo by Levi Call). Shoulder mobility can be both helpful and harmful!

Caitie told me, “On the mental side, I find that there’s a lot of waiting – waiting for pain to subside, waiting for an injury to heal, waiting to return to your favorite activities, waiting to meet with doctors and specialists. It’s hard not to get caught up thinking about all the cool routes you could be sending and sessions you could be sharing with friends if not for hEDS-related limitations. I often fear not being able to “keep up” with my able-bodied friends. On the bright side, all of the injuries and frustration give me a lot of motivation to work really hard when I can. It’s maddening when I’m really psyched about a climb but have to hold off until my body is healthy enough. Ultimately, I’ve had to reframe my perspective. At the end of the day, even if I’ve had a bad session, I’m super grateful to just be on the wall. Any day I can climb without pain is a good day!”

Tips for specific joints while climbing with hEDS:

The following tips are based on my personal experience, and things I have learned over the years in the community. Of course, keeping the joints in their healthy ranges and doing the correct physical therapy exercises are the fundamentals, but I’ve made notes on some specific joints below.

  • Ankles: My feet and ankles get the most irritated from splitter crack climbing. To deal with this, I tape my ankles for support. I’ve also tried using a larger climbing shoe so I can wear socks to add extra cushion for my foot when climbing cracks. My ankles sometimes hurt with a lot of slab/vertical terrain as well, so I’ll try to select supportive shoes, shake out my feet mid-climb, and take breaks as needed. Wearing approach shoes with ankle support can make my overall climbing days more comfortable for my ankles as well if a lot of hiking is required.
  • Shoulders: My shoulders most often get angry with steep/cave/overhanging climbing, or bizarre/shouldery moves. I am selective with the kind of overhanging climbs I choose to protect my shoulders. Similarly, if I see a crazy rose move or other shoulder-intensive move, I will typically try to avoid it or find alternative beta. If I must do it for the climb, I have to decide if it’s worth it — and if I opt to try it, I make sure I have solid feet to support most of my weight during the move.
  • Hips: My hips can get painful with a lot of stemming, hanging in a harness for long periods of time, or lots of heel hooking/toe hooking. When stemming, I try to move quickly if possible so I’m not spending a ton of time with my hips at a painful angle, and I alternate dropping one leg when possible to give it a rest/shake. For the harness pain, I wear a super beefy, cushioned harness to distribute the load better (like the Singing Rock Dome), and I try to be strategic with avoiding hanging belays on multipitches.
  • Wrists: My wrists tend to dislike slopers (a common issue even for folks without hEDS). When needed, I wear a low profile, compression wrist brace my PT recommended, and I find that it gives my wrist more stability. I also will do a simple wrap of tape around my wrist if I don’t have the brace, and it helps a lot. If my wrists are super angry, I avoid slopers as much as I can. Mantles can irritate my wrists, so I try to avoid those, or use other parts of my body to assist the motion as much as possible. My wrists also can get overstretched by the torque of hand jamming when I crack climb, so I will tape them for additional support, and limit the number of crack pitches I do in a day. Personally, I’ve found that finger cracks hurt less on my wrists (and ankles) than hand or fist cracks.
  • Fingers (and forearm flexor tendons): I’m lucky to have avoided any finger problems (perhaps since I’ve been climbing since a very young age), but many people with hEDS struggle with finger/pulley injuries and pain. X- or H-taping methods can provide support, and avoiding crimps, pockets, or whatever holds irritate your fingers can help until it improves.
    • I have torn multiple flexor tendons in my forearms from cranking on small pockets, so I avoid tweaky pocket holds when possible.
    • Appropriately dosed hangboarding can help build strength and resiliency, but must be taken slowly to prevent injury with hEDS.
  • Neck: Wearing belay glasses is critical for my neck pain. Having my backpack correctly adjusted and loaded also helps.

Allyson said, “When climbing outside, there are risks of hard catches or falling on crash pads that normally would not cause injury, but are riskier with me. All of this is very mentally taxing. While you are climbing, you are not just thinking about climbing, but are constantly evaluating the risk. It’s a skill that I am still learning — how to be cautious, yet bold.” With hEDS, we are always finding that balance while doing our best to climb!

Caitie also said, “One lesson I wish I had learned sooner is that taking a few days off when I’m experiencing a lot of inflammation is so much better than pushing through pain and ending up with a full blown injury. I haven’t fully learned this lesson by any means. It’s so hard for me to have the discipline required to rest when I don’t absolutely have to. But it saves a lot of time and frustration to prehab instead of rehab.”

Tips for belaying with hEDS:

  • Sit if you need to while belaying. I’ll usually sit while top rope belaying, but not while lead belaying. Some folks with hEDS use a wheelchair or other mobility aids, and there are great adaptive belaying methods out there to accommodate those!
  • Wear belay glasses. They help a lot with neck pain.
  • Use a belay device that is ergonomic for your hands. I love the GriGri — but find what feels best for you.
  • Find a comfortable belay stance. Sometimes outdoor climbs have awkward or loose belay ledges or stances, so trying to set up the rope and your body position to maximize comfort can help.
  • If you’re on a multi-pitch climb, try to plan the pitches so that you can avoid hanging belays if possible. I’ve found that linking pitches is one way to do that!
FallonPOTSBelay 2
Fallon showing off a seated belay using belay glasses (which also helps while belaying and climbing with an often related condition called POTS which you can read about here.)

How to support a climbing partner with hEDS

If you have a climbing partner with hEDS, hopefully they feel comfortable communicating with you about their symptoms, the challenges they face in climbing, and what you can do to help them. Asking relevant questions, being understanding and patient, and educating yourself on hEDS is a great start.

Some of the best things you can do to help a climbing partner with hEDS are:

  • Offer to carry more of the weight on the approach. Sometimes the hike is harder than the climbing because of joint pain.
  • Point out when their joints are being hyperextended or seem to be in a compromised position (with their prior permission – please don’t do this in an unsolicited fashion).
  • Encourage them to drink plenty of water and electrolytes, stay fueled with snacks, and rest a lot so they can maintain their proper joint ranges while climbing.
  • Offer to belay if you’re in a group so the climber with hEDS can spend that time resting and preparing for their next climb (plus it will save them neck pain)!
  • If they are frustrated with their symptoms, try to be understanding and remind them that it’s normal for performance to fluctuate depending on how their body feels. Ask if there’s anything you can do to help, or if they just need to vent.
  • Check in with them and communicate to make sure they are comfortable. Be willing to slow down or change plans if needed.

“I usually just want my partners to be supportive no matter how I perform that day. Some days I can push it and climb, but there are other days that I cannot. It’s a huge range. I like having people that are fun to hang out with and don’t care what grades I climb,” Allyson told me.

Caitie added that partners can support her by, “being flexible and understanding when I have to cancel a session due to pain or injury. When I’m climbing outdoors, it can be really great when partners carry some of my gear. I always want to take on an equal load, but I have to remind myself that my body can’t handle carrying a heavy bag of gear as easily as someone with sufficient collagen and stable joints. I’m not great at asking for help, but if I carry a heavy pack on a long approach, I often end up with significant neck and back strain that inhibits my climbing. Lastly, having a climbing partner who can lend an ear when I need to vent about hEDS is incredibly helpful. Non-paraclimbers may not understand what it’s like to climb with a chronic illness, but the more hEDS climbers describe our experiences, the more understanding and awareness there will be across our community.”

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