Rock-climbing teens suffer about as many injuries as young ice hockey or soccer players, most often straining or spraining their hands and fingers and developing tendonitis, says a new study from Canada.

The risks, the study authors say, are as high as 4.44 injuries per 1,000 hours of climbing.

More work is needed to explore what’s leading to the mishaps and how to prevent them, the researchers write in the British Journal of Sports Medicine.

“The hard part is that there isn’t yet enough research to definitively say what all the risk factors for injury in youth climbing are, so it is not yet possible to create injury prevention programs,” said Kaikanani Woollings, who led the study, in an e-mail to Reuters Health.

A 2013 report from the nonprofit Outdoor Foundation estimates that in the U.S. in 2012, roughly 1.5 million youth between the ages of six and 17 participated in bouldering and climbing, either indoors on artificial climbing walls or outdoors on real rock faces.

Woollings and her colleagues at the University of Calgary in Alberta found that 15- to 19-year-olds were 11 times more likely to suffer injuries in climbing or bouldering than 11- to 14-year-olds. The older teens were six times more likely to be injured if they had been hurt in a previous sport, and five times more likely if they used preventive taping for protection.

The 66 recreational and 50 elite (competitive) climbers in the study, who were recruited from rock climbing facilities in Alberta, answered survey questions about their climbing experience and their injuries in the past 12 months.

The elite climbers were mainly male and tended to weigh more than the recreational climbers, who were mostly female. The recreational group climbed an average of about seven hours a week and the elites climbed about 13 hours weekly.

Most of the teens spent an average of seven hours per week, nine months per year doing indoor climbing and six hours per week, three months per year doing outdoor climbing.

At least one injury per climber was the norm, and nearly a third of participants had multiple injuries. Adult climbers have a similar rate of injuries, the authors note.

After hand and finger strains and sprains, the most common injuries involved shoulders, knees and ankles. Nearly half the injuries were caused by repetitive overuse.

Falls accounted for 32 percent of injuries, mainly to the lower extremities. Half these involved the knee and ankle.

More than half of the climbers were treated for their injuries by a doctor or other health care provider.

Woollings, who is research coordinator for the Sport Injury Prevention Research Center at the University of Calgary, has been an avid rock climber since age 16, participating in three world championships. She also coaches a youth climbing team. Like most climbers, she said, she and her students have been injured in the sport.

Dr. Alan Ewert, professor and chair of environmental health at Indiana University in Bloomington, told Reuters Health that previous studies hadn’t focused on youth.

“I think it reflected what’s really happening out there,” said Ewert, who has done indoor and outdoor climbing for years.

“Given the fact that particularly elite climbers are active several times a week, I wouldn’t say (the injury rates are) high or low but expected,” said Ewert, who was not involved in the study. “It would be totally unexpected to not accrue injuries like that.”

Woollings said injuries might be prevented by warm-ups with stretching beforehand, especially involving the upper body, and then beginning with easy climbing and slowly shifting to more difficult climbing.

“I have known coaches to use shoulder injury prevention exercises from swimming and by the same token, we can use what we know from yoga, gymnastics and many other activities to help shape our own injury prevention strategies,” Woollings said.

“We should teach kids to be cognizant about their climbing - be smart, use safe practices, and if it hurts, stop.”