Ask Dr J – Issue 169 – Samurai sex for dummies

Samurai Sex

Will stretching help prevent injuries? If so, when should I stretch— before, during or after climbing?

Rosco Taylor Blue Mountains, Australia


Bending yourself into a position you saw in Samurai Sex For Dummies may be a great way of exploring existentialism, but for the most part it won’t help prevent injuries. Origami of the body is an age-old constituent of physical conditioning that has only recently been questioned.

For sure, stretching will increase the length of a muscle given time, but is that a good thing?

According to the majority of studies, stretching does not alter rates of injury no matter when you do it—before, after, during, on the phone, on your head or while sucking a lollipop. This epiphany made the avant-garde of coaching choke on their whistles! These studies, however, are monstrous epidemiological projects, which are less target-oriented than napalm. I have seen no studies that address climbing or any other specific cohort. Read: If you do general-type exercise, stretching will probably not help you. Too little is known to make evidencebased recommendations for climbers in this regard.

There is a correlation with increased injury incidence if you reside at either end of the flexibility spectrum. At the rubbery end, stretching may well catapult you further into the danger zone, where a joint can get into positions that do not allow for adequate muscle control and support, and hence get strained, sprained and generally screwed. If, however, you are stiff like a fossil, stretching will likely help you avoid injury. Interestingly, stretching a muscle will cause it to weaken for about an hour. If you are going to stretch the forearm musculature, or anything else, don’t do it just before leaving the ground and especially not on the jug just before the crux. Good general fitness, strength and a warm up that is thorough and related to the activity that follows, are highly linked with better performance and fewer injuries.


Pain In The Neck

What is belayer’s neck? Are there long-term problems associated with the condition?

Chris Ritz Boston, Massachusetts


Challenge 1: Hold your elbow fully extended under consistent but not excessive load for 15 minutes and tell me if it hurts afterwards.

Challenge 2: Hold a 10-pound dumbbell in your hand with your elbow flexed at 90 degrees for 15 minutes. Are your biceps squealing like the pig you imagined in Deliverance?

Cranking your neck back is no different in terms of stressing the joint in an extreme position. Let’s analyze this: you put your neck in end range, and make a bunch of tiny muscles (more than 20 on each side) support it … for a long time. Why are you surprised that it gets a tad uncomfortable? The pain you are feeling arises when both the joints in the upper neck as well as the controlling musculature become fatigued.

You could certainly argue that chronic extension of the cervical spine could lead to a few issues down the track. You may get headaches or experience a little dizziness, if you impinge a certain artery running through the vertebra. You may even get numb lips temporarily or your teeth will feel a little funny, but nothing that is long lasting or especially detrimental. Joint degeneration such as osteoarthritis requires significant preceding damage such as torn ligaments or cartilage. Running, for instance, is not a good predictor of osteoarthritis in the knee. In other words, “wear” is fine, “tear” is not.

Pain avoidance is surely key. Assume the position! In this case, that does not mean bend over. It means turn around. Or walk to the side. Or whatever it takes not to put your neck in a sustained position. Pain has more to do with duration than the position itself. Be the Ali of belayers—weave, dodge, duck and shuffle; if you keep moving you won’t get hit.

A few contraptions on the market may alleviate symptoms to some extent. In the 15 years I have been climbing, I have never seen one in use. And that probably sums up the general attitude. If you suffer badly, you might want to have a squiz online.


Blood Dance

Does elevation affect blood clotting?

Dave Costello Duluth, Minnesota


You’d think there were enough ways to die mountaineering. If it isn’t a cornice falling on your head or a hidden crevasse underfoot, your own blood will do a little death dance.

A deep-vein thrombosis (DVT) is a clot that forms, usually in the lower leg, causing a blockage. Moderately painful, it can easily be misdiagnosed as a calf strain. If it dislodges and settles in your lung, it is clinically known as rooted.

There is an increased propensity for DVT (and clotting in general) at high altitude (HADVT). The incidence of DVT raises 25 fold at the moderate altitude of 14,000 feet. Though coagulability peaks at about two weeks, it continues to be a problem for the lowlander for many months.

Activity at this altitude may offer some protection. The principal study was conducted on Indian soldiers with a mean age of 27 years. The average age of those suffering a HADVT was 40 years, and likely represents the soldiers who are dishing out the orders rather than those taking them.

Hypercoagulability has been implicated in several altitude- related conditions, in particular pulmonary embolism, pulmonary edema and mountain sickness.

Translation: vacillating in basecamp is a standing invitation for a lethal lung condition, so quit stalling—you may well be safer clambering up your beloved icicle, and then getting the hell out of there.


The Price of Obsession

My lower biceps on either arm right above the fold of my inside elbow frequently hurt when climbing very steep routes/problems or when campusing or training doing pullups/lock-offs. It feels like the pain is more where the tendon and muscle meet. Plus, when it’s flared up, the afflicted area is quite sore to rub. What’s up?

Matt Tengaio Idaho Falls, Idaho


I have seen this injury many times before, and have had it myself. Though it irritates me to say so, I am still not exactly sure what tissue is causing the pain. And I have seen it only in climbers.

Given the diffuse, anterior nature of your pain, the musculotendenous junction of brachialis is the likely culprit (brachialis is the primary flexor of your elbow, not biceps!). Corocobrachialis (CB), a weak flexor and adductor of the arm, may also be implicated.

This ailment is exclusively an overload/chronic strain problem, and generally follows a change in training or volume, e.g., starting campus boarding or being overly attached to a particular redpoint on steep rock. I see it much more in people during their first few years climbing … usually around the time obsession kicks in.

As I have mentioned in the past, the campus board is an elbow-consuming bush pig. Climbers often lose all their strength gains while recovering from the injuries it causes. It would be cheaper to pay someone to write you a program and monitor it than pay a physical therapist to rebuild you.

It is usually not too hard to rid yourself of this injury, but requires some habit recalibration in conjunction with manual therapy. First and foremost, put the bush pig on a diet and, for a month or so, climb slabs. I cover my bases and treat both CB and brachialis. Toe-curling deep-tissue massage and targeted stretching will be therapeutic if not enjoyable. You can try and stretch it yourself. As long as you don’t turn your elbow into a wishbone, you are unlikely to make it worse. Try this: with a straight elbow, put your hand on a wall at shoulder height. Turn away from your hand so that your arm points backward. Now face your palm toward the roof, keeping the elbow forcefully extended. Fine-tune it so the stretch is on the inside, just above your elbow.


Crunching and Cracking

Will cracking my finger joints cause arthritis?

Greenerfields Via Gear Guy Forum,


Addiction is a bitch, and knuckle cracking is not the smartest addition to your training program. The biggest misnomer here is that it will cause arthritis. The next is that it won’t. It is odd that one of the more common medical questions has garnered surprisingly little attention from the cognoscenti. There are less than half a dozen studies on the topic. Of these only one is useful.

Taking the results of one study as gospel would be the equivalent of academic hara-kiri. That said, this study was of reasonable quality and corralled most of the devil’s advocates. More pertinent to climbers than whether knuckle cracking causes a little osteoarthritis, or not, is an apparent correlation with weakened grip strength—knuckle crackers had a 25 percent reduction in static grip force.

Climbers are usually of the ilk that is only capable of understanding the present wide-eyed tense. For example: “Joint problems when I am 60? I am too young to ever become 60!” Well, the veteran’s section is going to be competitive in 20 years time and you might want to be there; or for that matter, just climbing. Although arthritis is probably not on the agenda for knuckle crackers, joint issues such as chronic inflammation and all the damage that goes along with that, albeit technically not arthritis (and this in itself is a dubious distinction), most likely are. So, will you get arthritis? No. Will your hand function be affected by similar symptoms? Yes.

A single crack when the joint is under duress is usually the result of a ligament rupturing, and is often not accompanied by much pain for several hours. After that it gets swollen, stiff and painful to move. MRI, go get one.

Crunching in a joint can be several things, but is usually quite a different sound. Often you can repeat crackles, where as the cavitations of a joint cannot be repeated for roughly 20 minutes due to biochemical shifts within the joint. Shoulders, ankles and wrists “crack” often, but are normally nothing to dial 911 over. Ligaments and tendons flicking across internal structures cause such noises.