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Rock climbing is gaining popularity. The injury patterns and safety practices of climbers have not been well described. This study seeks to identify the general injury patterns and safety practices associated with rock climbing.An anonymous multiple choice, Likert scale, and short-answer Internet survey was posted on several rock climbing Websites. Data were collected autonomously for a 2-month period in 2004. Demographic data were obtained and subjects self-identified their three most significant injuries. Participants were also surveyed regarding safety practices and training. SPSS 12.0 was used for statistical analysis and p < 0.05 was considered significant.In all, 1,887 subjects reported a total of 2,472 injuries. The mean number of injuries reported was 2.3 (SE 0.14) and 17.9% reported no injuries. Sprains and overuse were the most commonly described injuries, whereas fingers, ankles, elbows, and shoulders were the most commonly injured body parts. Some participants (28%) reported climbing under the influence of drugs or alcohol and these climbers documented more injuries (p < 0.008). Most of the injuries (77%) occurred while climbing at or below the subject’s normal climbing level. Climbers who participated in traditional climbing (p < 0.001) or solo climbing (p < 0.001) documented more injuries. Males had less helmet use (p = 0.019) and more illicit substance use (p < 0.001).Sprains and overuse were common climbing injuries, with the upper extremity being the most frequently injured body part. Rock climbers who participated in traditional or solo climbing, or who have climbed while under the influence or drugs or alcohol, reported more injuries.