Ask Dr J – Issue 192 – Ankle Mayhem

Ankle Mayhem

Recently I was working a boulder problem over and over with no success. Getting frustrated, I decided to try some new beta and found myself 10 feet up and sideways. I greased off, and fell onto my ankle, which rolled like Silly Putty. With a loud pop, it misaligned, and started ballooning, promptly reaching the size of a small elephant. I figured I had just sprained it, but x-rays demonstrated a few chips. How do I strengthen my ankle so that I don’t roll it when I step on a pebble? Should I tape my ankle when I get to go climbing again?

Noxiousfish / via


Oh, I feel for you. The sudden shift. The noise. The passing out! To say you have just sprained your ankle is akin to saying you have just scratched yourself, when in fact you’re squirting blood like a log arm sprinkler. You dislocated your ankle. You are going to suffer.

A few bone chips are the least of your concerns. These will be minor avulsion fractures caused by the ligaments on the outside of your ankle tearing bone off instead of snapping mid-substance. Some cartilage damage resulting from bones grinding across each other as they dislocated and then relocated is also very likely. When you take the boot off, though largely healed, your ankle will not be the same initially and the mechanics around it will resemble an engine with bent pistons.

To be honest, I would rather break my ankle—much quicker recovery. An ankle dislocation creates a gobsmacking amount of soft-tissue carnage, and is disabling for considerably longer than a break. You should be well recovered in 12 months or so assuming you work at it. My medical editor, Barrett, suggests writing the alphabet with your big toe to increase mobility after immobilization. Also, check out the ankle-stretching video on my web page. Exercises to increase ankle stability are imperative, like standing on one foot with your eyes closed and brushing your teeth. Get some professional help.

An ankle brace when you get the boot off is a great idea. Although I am as keen as you are to see you back on the rock, walking normally will be a better starting point. Then toproping. Leading on steep stuff should be straightforward as long as you don’t try heel hooking. Heel-toe maneuvers may induce vomiting.

Taping for a month or two is also advisable. A couple of stirrups going from the inside to the outside will give you peace of mind that it won’t go over again. A PT will be able to show you this as well.




I just had an appendectomy—it hurts like hell. The doc said no climbing for a month. What can I do without making myself worse? Can I do any training without my core? Should I give the Dodgy Elbows workout another go since my elbows are still sore as well?

Kolin | via e-mai


My considered opinion is that you are one poor fucker. Not only have you had your beloved appendix removed and thrown in the medical waste bin, your elbows are clearly still causing you some heartache. At least your wife climbs much better than you. You can live vicariously and proudly say, “I’m with her.” I saw a photo of your lovely and she looks like a weapon. I wish I looked that strong.

The doc is correct. You have stitches in your guts and there is no way around straining them if you pull even a hair from your nose. No climbing, edge boarding or anything of the like, and even shagging should be done in the starfish position. Doctor’s orders.

I know you started the Dodgy Elbow program (archived at some time ago. That it didn’t work may mean several things. First, that you have no commitment and are terrible at following instructions even though it is spelled out in the program that rehab will take some time and your elbows will likely become more aggravated in the short term.

Second, your lack of progress could mean that the diagnosis is wrong and you are dying from a rare tumor in your elbow. Get help! Or, last, the program needs tweaking. Ummm, get help. Since I doubt you will be able to find help for this last point, I offer this guidance: The elbow angle at which you do the exercises will define the effectiveness of the program.

Step 1: Read the article again.

Step 2: Start with your elbow straight and test the eccentric wrist curl. Now move it up so that your elbow is at 150º (from 180º) and repeat. Test again at 120º and so on. You are looking for the position of maximum aggravation. You want to target the exercise so it loads the exact portion of the common flexor tendon that is suffering with tendonosis.

Now, using the same protocol, test the tick-tock exercise in which you have weight on one end of the dumb-bell only. Both exercises should be done with fairly heavy weight, twice a day.

The work/rest ratio can have a profound effect on whether the program is therapeutic. Usually two days on and one day off work well, but you may find that a 1:1 is better for you.