Return to Rock Climbing After ACL Reconstruction

In this Rock Rehab Community lecture, physical therapists Jared Vagy and Sammi Iannucci present the first climbing-specific approach to returning to the wall after ACL reconstruction — drawn from the only two peer-reviewed papers on the subject. Jared opens with the backstory of the concept paper he published in Frontiers alongside a group of orthopaedic surgeons, an idea that started as a conversation walking out of the Frankenjura and was refined with input from clinicians at the Canadian Climbing Medical Symposium in Squamish. Sammi then walks through the case report she completed during her orthopaedic residency at USC, following a 50-year-old recreational climber from ACL rupture through to projecting — in a standard clinic with no climbing-specific equipment. The session covers the six-phase, milestone-based protocol in practical detail: why climbing demands like high steps, drop knees, and heel hooks aren't served by protocols built around cutting and sprinting, how to use the early phases to build finger and shoulder strength before a climber returns to the wall, and how drop hang testing can be used to both measure and train a climber's ability to land, fall, and roll. This lecture is designed for medical providers, coaches, and climbers who want a defensible framework for the hardest question in the process: how do you safely return someone to a sport where falling is part of the game? Topics include: Why field- and court-sport ACL protocols don't transfer to climbing Climbing as a high-impact rotational landing sport and its ACL injury risk Case report: a 50-year-old recreational climber, reconstructed via Achilles tendon allograft The six-phase, milestone-based return-to-climb protocol Strength and functional testing: dynamometry, adapted Grant foot raise, hop testing Drop hang testing for landing, falling, and rolling Psychological readiness and the ACL-RSI Staged fall progressions, return to bouldering, and the lead fall test