The VISA-C questionnaire: a self-administered assessment to measure finger/hand/wrist pain in climbers

Key points

1. 01VISA-C scores separated three pain groups significantly: no pain 83.2%, some pain 72.3%, activity-limiting pain 60.1% (p < 0.0001).
2. 02Scores were consistent across sex, age, race, and climbing ability level, supporting broad use.
3. 03Blood pressure was the only demographic or health variable associated with VISA-C score: elevated BP linked to higher scores (less pain).
4. 04Supplemental finger training was not associated with higher pain scores, even in climbers with 1 year or less of experience.
5. 05No single variable correlated meaningfully with both pain score and climbing skill level.

How it was conducted

Design

Cross-sectional online survey study

Participants

1,110 rock climbers aged 18-50 from 54 countries who completed the survey between November 5, 2024 and January 8, 2025

Questionnaire

VISA-C: 8 equally weighted questions (each 0-10 points), score converted to percentage out of 100; adapted from VISA-P and VISA-A

Pain grouping

Self-reported: No Pain (n=542), Pain without activity limitation (n=491), Limiting Pain (n=77)

Secondary outcomes

Associations between VISA-C score or climbing skill (IRCRA grade) and demographics, health, lifestyle, and training habits

Analysis

One-way ANOVA with Tukey post hoc, unpaired t-tests, and Pearson correlations; significance set at p < 0.05

What they found

• Mean VISA-C scores differed significantly across pain groups: No Pain 83.2% (SD 15.9), Pain 72.3% (SD 15.7), Limiting Pain 60.1% (SD 13.9); all pairwise comparisons p < 0.0001.
• VISA-C scores were not significantly different by sex (males 76.7% vs females 76.6%; p = 0.9318), age (p = 0.5230), or race (p = 0.1654).
• Blood pressure was significantly associated with VISA-C score (one-way ANOVA p = 0.0012): normal BP mean 76.4% vs elevated BP mean 82.5%.
• Years of climbing correlated positively with VISA-C score (p = 0.0045) but no significant differences were found between binned experience groups (p = 0.0851).
• Supplemental finger training type was not associated with VISA-C score in all climbers (p = 0.8292) or in those with 1 year or less of experience (p = 0.6510).
• Project grade (skill) was higher in males (mean IRCRA 20.7 vs 19.0 for females; p < 0.0001) and decreased with age (p < 0.0001) but was not associated with VISA-C score (p = 0.3388).
• BMI did not predict VISA-C score (p = 0.1654) but did predict project grade negatively (p < 0.0001).
• Diet trended toward significance for VISA-C score (vegans 81.5%, vegetarians 78.0%, meat eaters 76.3%; p = 0.0686) but did not reach significance.

Limitations

• Self-reported data cannot be verified; no clinical diagnosis confirmation was obtained for any participant.
• Sample was heavily male (90%) and recruited largely via a climbing-focused YouTube channel, introducing selection and recruitment bias.
• The survey was available only in English, potentially excluding non-English-speaking populations.
• Cross-sectional design captures only a snapshot of current pain; test-retest reliability and longitudinal validity were not assessed.

Why it matters

For patients

Climbers can use the free 8-question VISA-C to track finger and wrist pain over time and gauge whether their pain level warrants modifying training.

For clinicians

The VISA-C provides a standardized, demographic-neutral outcome measure for monitoring climbing-related hand and wrist tendon injuries in research or rehabilitation settings.

For readers

This study introduces a new validated tool for a sport with high hand injury rates and highlights an unexpected link between blood pressure and lower injury burden that warrants further investigation.