Ask Dr J – Issue 182 – Strong to the Core


Four months ago I severely injured my abdomen while doing side-toside crunches on an inclined board. At first I was certain I had a hernia. The pain is centered one inch below and left of my belly button. My symptoms were swelling, bruising, severe pain from belly button to “very low”… and a bulge that stuck out of my stomach. After many doctor’s appointments where various hernia diagnoses were ruled out, I was told that I tore the rectus abdominal muscle. A year on and tying my shoes still feels like a V12. My surgeon told me that surgical repair is not an option and that even with PT I probably won’t be able to climb again. Climbing has always been the spiritual and grounding force in my life and I am very discouraged.

mkruzic | Forum

Backflips—the y see med easy enough. I had practiced a few times on a beach in New Zealand where my partner and I had taken up residence for some world-class hanging out. On that fateful day my hottie and I were at a local ski area riding the natural half pipes. Too much snow for bouldering. Like the edge of a cliff, the precipice of a half pipe has a certain magnetism.

Nerves fired, hormones surged and my maleness amplifier roared like one of those teenage vampires in heat. Rationality rode away with the snowflakes. Toes on the icy edge, eyes wide and canines bared, I cranked it over. Apparently doing it in shorts on a beach is quite different than hauling all that regalia in pow-pow. Perhaps I should have sucked someone’s blood first.

In the weeks that followed, my abs hurt so much I could not even lift my head off the pillow. Luckily my girlfriend was pregnant already. Luca is now 4 and my abs, though a bit more hairy, are like kryptonite molded into balls of contractile flab. Read: quite normal.

I draw the line at such irreverent advice as telling patients that they’ll never climb again. People climb without legs, uno! One of my friends is bald, no less! He also has one eye, is pushing 60 and crushes like a steamroller. At least you can rehabilitate your abs. His hair is gone forever.

There is something not quite right with the level of investigation and the “inoperable” tag. By the sound of it you have not had an ultrasound or MRI, which are really the only two investigations worth acquiring for an abdominal tear. I may be going out on a limb here, since I am not an abdominal surgeon, but get another opinion from a more sportingly inclined physician, or at least someone willing to give you some more time and explanation.

You haven’t detailed your rehab program or what the PT has been doing so I can’t say too much about that. I have not seen a tear that could not be corrected with some finicky needlecraft and tailored rehab. Give me some more details on the forum and I am happy to direct you as best as 10,000 miles away will allow.



About a month and a half ago I was working a project that involved a serious left-handed pinch using just the pointer and thumb. The next day I noticed that my thumb clicked whenever I extended it. It still does. No pain when pinching, but a weird feeling when I do barre chords on the guitar, and still the clicking on extension.

mattleaf | Forum


The lesser -kno wn variety of trigger finger, “trigger thumb” will garner no more sympathy than a runny nose and will attract such comment as, “Yer, my mum had that when she did Realization.”

I agree. Shut up and climb. Like knee-bars, thumbs are cheating.

As with trigger finger there will be a thickening in the flexor tendon. This catches at the aperture of the surrounding sheath and causes the trigger sensation.

In all likelihood it will correct itself, usually within a couple of months. Have a read of Ask Dr. J issue 175 at www.drjuliansaunders. com for a little more info. If the clicking is more irritating than disabling, I would try to ignore it while engaging some of the allied therapies such as acupuncture. Cortisone can be helpful and complications are unlikely, though if you do get them they can be far more problematic than the condition.



Today when bouldering, I went up for a two-finger crimp with the middle and ring finger of my left hand. I’m pretty sure I heard the tiniest pop, then my ring finger went out and I felt pain in very specific spots: A) mild discomfort between the knuckle at the base of the ring finger, and the next knuckle up the finger, B) pain in the palm and C), for the first hour or so there was pain about midway down the forearm that I actually can’t duplicate right now.

Alex | Forum


I have been documenting this injury for many years and really, I should get off my lazy ass and do some research into what exactly is torn.

The mechanism is virtually always a training condition known as hyperzealopathy, whereby the climber is unable to recognize imminent injury. The two most common situations are carrying your over-laden shopping bags with one finger or pulling on a hold with one (or two) fingers with the little and/or ring finger tightly curled into the palm.

SHIZZLE! Not only did it F#%* hurt, but now you can’t get it to hurt again. Wassup with that? It won’t hurt unless you replicate the tightly curled finger. Try the Dr J Test described in Ask Dr. J issue 172 (archived at www.drjuliansaunders. com.)

I recently saw a research paper written by a less lazy practitioner who suggested the pain might be arising from a tear at the insertion of one of a group of small muscles in your palm called lumbricals. Unlike other muscles they attach to corresponding tendons that control flexion and extension of the fingers (rather than two bones). These are subject to severe elongation forces when adjacent fingers are loaded at opposing lengths.

As you have noted, there is pain in several spots. Your presentation is the stock standard. Being in multiple sites, the pain pattern makes definitive diagnosis a nightmare. I have always assumed the tear to be in the forearm where the flexor tendons come together and attach to the primary flexor muscle, flexor digitorum profundis, and the palm pain was referral. Gosh damn! I am not the repository of all medical wisdom—it could be the other way around or even involve both sites.

Frivolous details like location need not impede management. You can pretty much climb as hard as you want if you follow one simple rule: don’t split your fingers. Can’t control your middle finger? Give them the relaxed “bird.” The half-crimp, where the middle two fingers are crimping and the corresponding fingers are technically open handing, can also be tetchy. This creates a minor shearing and, depending on the severity of injury, may be aggravating. If you are open-handing and your little finger is not long enough to be on the hold, then be sure not to curl it into your palm. Same with crimping if any fingers can’t fit on the edge. Try and stack them under or on top of neighboring fingers. Though a little tricksome, it is better than laying off completely and focusing on your belay technique!