Last week I spent several hours aggressively wirebrushing the lichen off a dirty new climb I was bolting. The next day the area about an inch below my hand (sort of where the forearm starts but still maybe considered the wrist) was swollen and super sore. Now that area is still swollen and it hurts to climb slopers. What’s up and how do I treat it?

Jack Johnson/Peoria, Illinois

You either have de Quervain’s tenosynovitis, orintersection syndrome. Both are inflammatory conditions that occur on the thumb side of the wrist on the back of the hand. The former involves the tendon sheaths of two of the thumb muscles, whereas the latter irritation is where these two tendons cross over two different tendons that extend the wrist. Given a medical degree and a very small ruler you can tell them apart, but why bother when your doctor will likely give you the same script and the same brace.

For starters, you shouldn’t brush so vigorously when you are physically ill-equipped. Aside from that, you are clearly cleaning too aggressively and don’t deserve any form of help—let alone for free. Report yourself to a public climbing forum, where you will be chastised and ridiculed by invisible people wearing finger cots so that they can type faster.

Anti-inflammatory meds and immobilization can help if the injury is debilitating. Otherwise stop annoying it (and the ethical evangelists). Massage your forearm and the swollen bit above your wrist gently a few times a week for 20 minutes for the next month.

If you need to do more brushing you may want to train at home once the swelling has settled down. Try cleaning your car engine with a bunch of flannel flowers. In the meantime, washing dishes is a no-no. Tell Wifey that you need to strengthen your constitution through rest and happiness. She will know what to do.

 

I have a really bad case of toenail fungus brought on by 30 years of too-tight climbing shoes. Any advice on nuking fungus?

JJ/Carbondale, Colorado

Does your partner pull away when your feet touch in bed? I feel sad for you. You can’t tell someone you have a fungus and expect sympathy. They will cringe, and possibly don some form of latex.

I don’t often see toe fungus in my office, but rather at the crag when a climber is trying to get that crustacean into a shoe.

The most common culprit is a group of fungi known as dermatophytes. Climbers are prone to the disease more so than the normal population because we continually cram our feet into tight, sweaty shoes where the fungus can run amok. Typically, the nail will thicken and become crusty. It may change color and stink like the breath of a Balinese dog.

Being the vain society we are, it’s no surprise that there are an array of tonics and tinctures to return you to the love shack with the lights on.

There are options such as laser therapy for the financially cavalier, or cheaper alternatives such as smearing the toenail with Vicks VapoRub (I shit you not, it’s proven to be quite effective). Other modalities include medications (with the usual side effects that may kill you), nail paint and aggressive debridement in combination with all of the above.

Unfortunately, very few people actually recover at all. Not because even the most hippie of treatments—like thyme oil—won’t work, but because the fungus is as recalcitrant as an African warlord. No matter what treatment you employ, none are quick—six to 12 months is a best-case scenario.

Patients rarely see the program to its end and the fungus, nestled into a defensive anatomical hidey-hole, lives on.

 

Does bat hanging in inversion boots help a bad neck? When I belay and look up, my right triceps twitches and aches. If I immediately look down and left, the agony goes away. I have had three vertebrae fused in my neck.

Dan Ramos/Homer, Alaska

The problem is that the fused vertebrae no longer accommodate much mechanical load. They are not so much the cause of your pain, but the neighboring discs are suffering structural fatigue.

The nerve root exits the spinal column through a small space between the vertebrae known as a foramen. Space-occupying lesions such as a disc bulge or bone spur can place pressure on the nerve as it passes through this space. In simple terms, nerves do not like entrapment and they will let you know in no uncertain terms, pain being their number-one messenger. You may also get numbness, twitching and weakness in your hand and/or arm.

Inversion can reduce pain while you are inverted because the weight of your head tractions the vertebra, increasing the size of the foramen. The head position you describe that relieves your pain essentially achieves the same outcome.

There is, however, no evidence to suggest any therapeutic effect outside of transient pain relief limited to the time you hold the position. Belay glasses are your friend. Gentle stretching is a worthy exercise. Be careful with yoga. Most instructors don’t realize that climbers have no physical hand brake and will go hard until something gives way.