Ask Dr J – Issue 179 – What does Obama’s vegie patch and your elbow have in common?


I have pain and swelling on the joint at the base of my pinky. The pain is point specific to the palm side. It hurts to bend or straighten. Grasping (steering wheel, ski pole) hurts a lot, seemingly more from contact than bending.

Have I avulsed something? I have no recollection of anything sudden. Lingering in my mind was a big sideways deadpoint from a slot-shaped hold about a week ago. There was no immediate pain or irritation. I would climb, notice a bit of soreness the next (rest) day, lather, rinse and repeat. Yesterday I woke up to extreme pain, swelling at that joint, and with the complete inability to make a fist. This all started about a week ago. And now, 36 hours after it peaked, it’s all gone



That is a strange one, Lisa. I think I would have a better chance at understanding baseball.

An avulsion injury is unlikely. They go off like a U.S. “peace-keeping” rocket launcher—BANG— sudden detachment, exploding pain and an inability to move.

Tuesday night Fight Club must have been disappointing if you couldn’t make a fist; I’m sure you are still a weapon even with only one bazooka. Clearly, it was transient inflammation of some genre causing the restriction. It smacks of a cyst given the location and evanescent nature, though the particularly sudden resolution is a little odd.

An inflammatory arthritis, neuritis, a sting? I’m clutching at straws here in the vague hope of a needle stick injury.

If I were pressed for a diagnosis I would say appearances are vaguely consistent with a cyst. And since it’s gone I can’t be proven wrong. Perfect. I wouldn’t worry about it. CLIMB ON! If it returns, procure an ultrasound and x-ray. That’ll be $5,000.



I’ve got an injury in the left biceps close to the elbow. The pain appeared after I tried a route with hard undercling moves two months ago. After resting for two weeks, I tried to rehab the arm with curls at low weights but this still causes pain. Something feels wrong when I do supination [rotating the forearm from palm down to palm up] exercises with my elbow at 90 degrees, holding a one pound hammer. The MRI showed some inflammation/ edema around the ulna insertion. I’ve had lots of physiotherapy (friction massage and ultrasound), done no climbing or training, and am just doing the curls from time to time.

TOM BRAUN | Rock and Ice Forum


A year ago I went bolting even though I had learned long ago that bolting is no more a rest-day activity than practicing back flips (tried that: WRONG!). Something bad happened that fateful bolting day, because the following day when I went out the back door to let the chooks out, I lifted the door slightly and … AHHHHHH! SHITZER!

Since then the pain has fluctuated, but to this day underclings piss me off only slightly less than the radiation from my mobile phone.

Although there are some genetic variations depending on whether your progenitors prowled beyond the local precinct, there are usu ally two tendons that have separate attachments to the radius (there are two heads to the bicep). An additional superficial attachment extends across the front of the forearm over the ulna, though it is not certain what this actually does (other than get injured).

This latter anchor, known as the bicep aponeurosis, is the likely point of damage. Strains to bicep insertions at your elbow are uncommon. I am tempted to say it is more common in climbers but since I don’t see many other people that could be misleading. Cage fighting? Dwarf throwing?

The pain pattern and history is typically quite similar to that of tendonosis, though I have not seen a radiology report suggesting as much. Try this recipe: three teaspoons of religious-strength zeal each morning. Add to that three sets of 10 repetitions, morning and night (start with two sets for a week or so) of eccentric bicep curls that incorporate a 180-degree twist of your forearm (from palm facing your shoulder to palm facing your thigh). Three days on, two days off.



I use an old Pusher Powerjunkie hang board and I’m concerned about the angled geometry of the main jugs. In the past I have had elbow problems. Is it bad to do pull-ups on grips that are not horizontal? Do you think that this setup could have a negative effect on my elbows? Is it healthier to have the grips set up horizontally as most other hang boards do?

boredEnuf | Rock and Ice Forum


I hate hang boarding. Aside from some vague mechanical similarities, it is everything that climbing isn’t. Did I mention the brain-numbing boredom? That said, I bore quite easily. And I’m weak …

Hang boarding is the fodder of finger strength. Muscle strength, as opposed to tendon strength, develops faster than it took the conservatives to denounce Obama’s veggie patch as heretical environmentalism. When the holds are angled rather than horizontal, your wrists are cocked to the outside. This causes excessive loading of flexor carpi ulnaris (FCU)—the drama queen of your musculoskeletal system.

The moonshine of modern training, hang boarding can be the distillation of chronic finger overload. FCU is tempestuous by nature and this training method has the propensity to catapult you into tendonosis. Training on angled holds is not so much poking funny faces at FCU as it is punching it in the nose.

Many studies have shown that strength and stability are maximized in neutral. Sonnie Trotter had similar issues with angled holds and outlines as much in his blog. Theory, and anecdotal evidence like yours and Sonnie’s would suggest that anything outside of neutral is more inclined to cause an elbow tantrum.

The distance between the holds is also a factor. A very wide or narrow grip will push the wrist out of neutral and invite punitive damages. Horizontal holds on a standard width board are the way to go.

Like animals low on the food chain, your elbows have an aversion to surprises. If you can’t design or follow a program properly, pay someone to help you. It will be cheaper and less painful than rehab. Pull-ups alone are a complete waste of time.

Pull-ups on a board are a close second. Think beyond the box. For example, erect an easel several feet behind your board. Tape a paintbrush to your toe. Now hang from your beloved board, pull into a front lever, and paint a portrait of your favorite celebrity. I am good at dead presidents and porn stars since they are fairly ugly anyway.