I Tore My Knee: When can I resume bouldering?

I am 16 weeks out from an ACL reconstruction and meniscus repair. I hurt my knee in March 2009 and had surgery in August. While I have managed to be patient, there are times when I get discouraged. I am pretty certain my surgeon doesn’t understand bouldering. When will it be safe to boulder? I have been toproping without any problems.

Robyn Tesauro | RI Forum

 

Unless your surgeon has landed from 15 feet up and missed the crash pad, she doesn’t understand bouldering. But I would bet my last dollar she gets it enough to know it’s not cool for you to start again too soon.

Toproping is fine, but avoid difficult high steps and deep drop knees. You can lead in another month or two. You could lead now on easy, gently overhanging cliffs, but only if you are very comfortable letting go if you even vaguely feel like your knee is being compromised.

Bouldering is fine as long as it’s in your dreams. At 20 weeks, your knee will hopefully be strong enough to handle it, but don’t bet on it. If you have pain-free motion, no swelling, can run and hop in all directions, have a great tan, and it doesn’t bother you while you’re working, playing or shagging, then you are certainly in the starting blocks. Try a gym with salubrious padding and spotters the size of Vikings. Landing on harder surfaces, like your typical crash pad, is not in the cards until your knee has its 40th birthday.

Relax. You are on the way to finding the Nirvana equivalent of patience. Well done, and hang in there. Damaging your ACL is not like splitting your tip—“Oh, gosh darn. Now I’ll have to take a rest day.”

No. More like a rest year. Take your time, rehabilitate thoroughly, and follow the advice of your P.T. There are definitive milestones that will tell you how your knee is doing. Eventually you will forget which one was injured.

 

 

I have a SLAP lesion [a cartilage tear on the rim of the shoulder socket] having injured my shoulder seven months ago. My D.O. gave me a cortisone shot yesterday and I actually feel worse. I have started P.T. I don’t want to have surgery, but not climbing is bringing me down. All of my therapy is geared to the supraspinatus.

Matt Kandrick | RI Forum

 

I like the cut of your jib, sailor; that’s a fine plan.

I’m not sure why the P.T. is concentrating on your supraspinatus muscle, given that you have not mentioned a tear in it (which would have shown up in the MRI). Certainly, exercises that target the four muscles that constitute the rotator cuff (supraspinatus being but one) and shoulder control in general are worthy.

If the supraspinatus is in pain, then it is surely secondary to another issue. Concentrating on it is like cleaning your windshield while driving through a mudslide. Given the reverence with which the supraspinatus is treated in modern rehab, anyone would think it were the global CEO of shoulder motor control, when in fact it’s just middle management.

Most are simply fraying of the cartilage edge (Type 1) and the vast majority will settle. Still, it is difficult to know what the correlations are between the extent of damage and the need for surgery, since even MRIs are unable to reliably reveal the extent of damage to the glenoid labrum. The upshot is that we don’t really know how many of the more serious tears actually settle without surgery.

There are four basic types (and some sub-genres) of SLAP lesions. The best indicators for surgery are ongoing pain and/or a sense of locking in the joint. Pain that takes several months to settle is quite normal. Seven months is a long time and if it has not settled in the next few I would certainly consider surgery.

Strengthening the shoulder now will double as “prehab” if you end up needing an operation, so your time is far from wasted. If you have any sense of locking in the joint, like something is getting stuck and you have to reverse the movement to free it up, talk to your surgeon. The damage is likely to be extensive and surgery is really your best option.

 

I had a proximal bicep tear reattachment surgery. However, after two months the tendon tore loose from the insertion point. I can have another surgery or I can just live with it. I am 56 and climbing is my way to stay fit. If I have the surgery it will take at least six months (which seems like a long time at my age) until I am able to climb again. Options?

Lynn Purser | Huntsville, Alabama

 

Six months is the same whether you are 16 or 56. It’s a science thing. You are still in the prime of your life—suck it up, Princess.

Without the bicep attached, you have the cosmetic issue of it sitting just above your elbow—which makes your arm look a bit gammy. This alone would have me running back to the surgeon. I thought that male pattern balding would humble me, but no, my vanity remains as strong as the Jedi Force.

Second, keeping in mind that these are rough numbers and I’m assuming you have ruptured the long head of biceps, you will have some loss of power, which will remain at about 10 percent for elbow flexion and 20 percent for forearm supination (palm down to palm up with the elbow flexed). With surgery, you will regain somewhere between a little and a lot. There will be some loss of shoulder strength but this will not be alleviated by corrective surgery.

I would have the surgery, but I am both vain and rather attached to what little strength I have. In the long term you should be moderately better off having the surgery, assuming you don’t die under anesthetic or lose your arm to a staph infection.

I do wonder why the first operation failed at two months. Was it a rehab issue? Isolate and mitigate that risk before you even consider another operation.