Ask Dr J – Issue 170 – The ‘Paris Hilton Test’ of Worthiness


I’ve had elbow tendonosis for the last year and am finally back to climbing pain free. A physical therapist has told me that weakness in my wrists may be placing greater loads on the elbow tendon, and that taping the wrists before climbing might help. Any thoughts?



Hmm, not too sure where your therapist is heading with this one. Virtually all the muscles controlling the wrist arise from either side of your elbow, the flexors from the common flexor tendon on the medial side, and extensors from its alter ego on the lateral aspect. Assuming you have medial epicondylosis (see Medicine, No. 156), the muscle usually afflicted is a wrist flexor sporting the handle flexor carpi ulnaris (FCU). Your therapist’s explanation, if not his/her understanding of tendonosis, leaves a lot to be desired. In this malady, the muscle is actually too strong and as a result, is damaging the common tendon at the origin of FCU. It is the tendon at the elbow that is too weak, not the muscle, or the tendon at the wrist as it inserts into one of the carpal bones.

It is possible your PT is referring to laxity (flexibility) in your wrist, and translating this to read instability. The two, however, are by no means linked. Instability is dependent on weakness or loss of motor control, whereas laxity simply means you missed a career performing a triple overhead backbend, your gonads adorning your forehead, while at the same time juggling Oompa Loompahs. At this end of the flexibility spectrum you have a higher propensity for injury (see Ask Dr. J, No. 169), but I would recommend proprioceptive/ strength-based exercises rather than prophylactic taping. If ulna carpal instability were the case, you would almost certainly have suffered recurrent pain on the little-finger side of your wrist long before a chronicoverload injury at your elbow.

Taping for prevention is at best futile, and at worst detrimental. Many PT’s love tape. More than a few missed their calling in the bondage industry. Taping to protect an existing injury, by restricting its range of motion, can be very helpful, though that, too, can cause problems.

The wrist, of all articulations, is one of the more likely to suffer from pointless restrictive taping. The narrowest part of your wrist contains 23 tendons, half a dozen major blood vessels, three major nerves and several minor ones, eight bones and a whole bunch of other stuff that is highly dependent on what little space there is. Do you really think compressing all of this will enhance performance? At the very least you will get pumped faster.



I heard that bouldering increases bone density in a climber’s hands, while climbing routes does not. Is that true? Also, what is the significance of increased bone density?



My inner child is coughing. The issue of bone-strength adaptation is a little more complex than that. For starters, there are no studies looking at this specific issue, so it is theoretical with regard to scampering on rocks, whatever your penchant, bouldering or routes.

I assume you are talking about bone strength, which is both bone mineral density (BMD) and bone size (BS), i.e. wall thickness, cavity size and total area, among other parameters.

The crux of your question involves five variables: high-intensity exercise versus more endurance-based activity (bouldering and route climbing, respectively), the two aforementioned indices of bone strength, and time. Any adaptation is specific to the amount of load at the site in question.

Current research suggests that high load and low repetition will increase BMD, as well as bone size, faster than endurance-based activity in the relative short term.

Route climbing does not really fit into the endurance category, but rather somewhere in the middle of the powerendurance continuum. As such, you could argue that bouldering, which is positioned at the far end, produces greater gains in bone strength in the short term due to its higher intensity and greater rest period between bouts.

Recent studies illustrate cortical hypertrophy (bigger bones) in climbers, but since many comp climbers use bouldering as a training medium, and this was not a control parameter, this is not a definitive result. I suggest that if bouldering and route climbing were separated, boulderers would show more bone adaptation than climbers of a similar standard who did not train finger power. But it’s a Paris Hilton study—a no-brainer complete with hair splitting.

Most of this is really only pertinent for post menopausal women, since bone strength, BMD and bone mass are not especially significant for the average climber other than a curious footnote.

To answer your question: Yes, you will have stronger bones in your fingers, and to a lesser extent in your arms, if you boulder a lot. More so than for route climbing. If you drink a lot of cola this may be negated, however, since cola is known to reduce BMD!



I’ve heard that Nalgene bottles are unhealthy. Will drinking from a plastic bottle make me sick?



Dyslexic sperm are to the body as a dead canary is to a mineshaft. Remove thyself before the canary dies! After being prompted to have a squiz at some health concerns surrounding plastic, I threw out all the plastic that was not bolted down or brushed on. An overreaction? For sure. It’s possible that I will not be healthier for it, but I certainly won’t be less healthy.

Bisphenol-A (BPA), a chemical that leaches from polycarbonate plastic, is a known endocrine disruptor that mimics the hormone estrogen. Different types of plastics off-gas varying amounts of BPA.

The plastic industry says BPA is harmless, but of course they would! Call me cynical. Like the tobacco industry and, more recently, the mobile-phone industry, they have a suspicious propensity to be the hidden sponsors of many studies. Results of these should be treated with more skepticism than the assertion that the War on Terrorism is about democracy and not oil. Call me cynical, again! I’m OK with that.

The weight of scientific research suggests that BPA, when isolated and in concentrations within FDA regulations, is not clinically relevant for humans. However, the ubiquitous presence of synthetic estrogen in the environment (not all from plastic products) is a persistent suspect for endocrine pathologies such as breast and testicular cancer, sperm that swim in circles, yada yada.

I might mention here that DDT, one of the more toxic chemicals ever sprayed about the place en masse and now illegal almost everywhere, was considered so safe it won the Nobel Prize for science. The road from Genius to Disastrous was very rough indeed.

Though you may not need a chemochaser after drinking from a plastic container, you’d be a nong to think that BPA is bio-friendly. And even more stupid to assume that it does not participate in the cumulative assault on our immune system, which, I am at pains to point out, has not mutated to protect us from 21st century toxins— toxic shit is still toxic!

No data yet proves a causal relationship between environmental estrogens and illness or disease in people. That said, cautionary behavior should sit at the citadel of modern Darwinism.

Cancer and chromosomal abnormalities are on the increase—sharply! Why? Probably lots of reasons, and BPA when combined with all the rest might just be the straw smashing the camel through the tectonic plate. There is considerable evidence that people today are living in a more toxic environment than they used to. For instance, you have a greater chance of developing cancer if you reside in a new house rather than an old one. Is it due to all the space-age polymers holding it together?

With the cocktail of pollutants that our bodies deal with on a daily basis, why not try and minimize one?