Ask Dr J – Issue 189 – Ruined!


I started climbing six months ago and gradually increased my level to a lethal week: four straight days of hard bouldering and in the following week three days of trad, before my more experienced friends took away my rock shoes and booked me in with the physio who diagnosed elbow and knee tendonosis. I have since seen professionals, and the common denominator seems to be my hypermobility. I’m sticking to my stretching and gradual strengthening routines (incorporating your advice in “Dodgy Elbows,” No. 156). At what stage can I go back to the wall? Is it a good idea to build up shoulder strength to support grumpy elbow tendons? Are pushups recommended?

Sophie | Rock And Ice Forum


In a nutshell, you can rest as long as you want, but gain nothing in the long term. If you are relying on that option you might as well take up synchronized swimming.

When I hear that hypermobility has been a major contributor to a certain condition, there are usually two possibilities: a) the patient hasn’t understood or, b) the clinician has no idea.

There are two scenarios: first, your elbows are sore because they are a bit loose, albeit you work them in a fairly moderate range of motion while climbing (i.e. little or no hyperextension), or, second, your elbows are sore because for the last six months you have spent an obscene amount of time hanging on by your fingertips in your Jesus pose. Mmm, that’s a tough one. I’m going to go with chronic overload related to your (s)training program.

One of my patients can, quite literally, sit on the back of her head! I treat several contortionists, none of whom are falling apart due to their extremely strenuous circus acts that often require gob-smacking strength and repetition. Why? They train like professionals.

Hypermobility does not translate to instability, whereby you might expect chronic tendon pathologies. In your case, however, a lack of tendon strength, not hypermobility, is the single factor that has you traipsing down the merry path of selfdestruction. If hypermobility has any role at all, it will be minimal.

Just like there is a leisure class at each end of the social spectrum, there are more injured people at each end of the flexibility spectrum. Certainly, more flexible people have to be careful about loading a joint at its end range, where strength and control diminish significantly, and the likelihood of an acute injury is amplified. Training these two important variables will mitigate the risk greatly.

Your primary malfunction is not hypermobility, however, but rather a combination of that beautiful, ephemeral, wide-eyed excitement you see in some people who climb—and a body that is not conditioned. Rein in your mustang of enthusiasm and let those poor tendons recover a little.

An eccentric rehab program [like that described in “Dodgy Elbows”], in conjunction with modified training, bad-habit expunction, and a little manual therapy is consistently effective for tendonosis. If they are not working then either the program needs tweaking or the diagnosis is likely to be incorrect, in which case an MRI would help clear things up (I mention this more in relation to your knee issues).

Shoulder strength, excellent idea. Pushups – average exercise. Hypermobility – irrelevant.



Brad and I had big plans this summer, but on Easter Sunday he broke his femur and shattered his kneecap in a moped accident. They put a rod in his femur and salvaged a third of his kneecap, but it was a long recovery. The doctor said he might never run or jump again. Brad doesn’t like being told what he can’t do.

Curious and Hopeful Liz | Rock And Ice Forum


On the day of The Resurrection! The Lord does work in mysterious ways, but my first question is: “Why the wrath?” Confession might be a good place to kick off your rehab!

I’m surprised they didn’t just put a prosthetic kneecap in, but I’m not an orthopedic surgeon. Listen to them. They will have a plan and be able to advise you on likely outcomes. That said, their advice surrounding climbing is often rather irreverent and I take umbrage henever I hear: “Thou shalt not climb hereafter.”

That Brad does not like instructions is both an asset and liability when it comes to rehab. Undoubtedly he will be told most sports are off limits and climbing will be at the top of that list. However, marathons, doggystyle and virtually any high-impact sport will be out unless he is begging for a titanium knee.

Climbing will certainly be possible but don’t expect it to come easily or be pain free. I am not sure how much or what bits of the patella remain (very important variables for both treatment and prognosis), but Brad is looking down the barrel of some early degeneration in his knee due to incongruent articular surfaces and/or simply a lack of articular surface.

Short of lying on his back and waiting for a heart attack, any activity that is weight bearing will speed degeneration. Although death by heart disease will defuse the situation, it’s somewhat counterproductive. And therein lies my point— take any anti-activity advice with a raised eyebrow since you must counter it against all the other benefits, not least of all mental health.

I can’t say I have seen a climber with a remnant third of a kneecap. I have a mate who has no kneecaps. But he has no legs so that makes sense. He climbs pretty well: Tasmania’s Federation Peak. Africa’s Mount Kilimanjaro. El Cap. Can’t argue with that.

Brad, for 15 minutes imagine you have NO LEGS. Really, think about this for 15 minutes in as much practical detail as you can. Now add one leg back. Consider this for another 15 minutes. Now the other leg. Additionally, for no extra charge you just scored a set of ankles, the Lord’s magnum opus of joints and sensational for angling on those shitty little smears. Now add one and one third kneecaps back. Wow! Look how much you have! Praise the Lord.