The objective of this study was to compare patterns of injury found in traditional rock climbing with those found in sport climbing. A questionnaire was administered to rock climbers by mail, in person, and via the World Wide Web. Injuries that occurred while rope-protected climbing on rock were analyzed regarding the anatomical location and the mechanism and activity at the time of injury. Ninety-four climbers reported sustaining an injury while rope-protected climbing on rock. Most injuries occurred while leading and involved the upper extremity, especially the fingers. Falling was the predominant mechanism of injury on traditional climbs, and stress over a joint while attempting a difficult move was the most common mechanism on sport climbs. Potential for injury prevention lies in teaching climbers to recognize the limitations of the fingers as weight-bearing structures.