Ask Dr J – Issue 196 – Out For Life?

Out For Life?

I’m a 25-year-old female. I tore one of my radio-ulna [RU] ligaments and the triangular fibrocartilage complex [TFCC] two summers ago. I had surgery and went through all the rehab. Two months later I re-injured the wrist, this time tearing both RU ligaments. More surgery, immobilization and rehab. After four months of climbing I feel stronger than ever. However, I can also feel the popping and cracking coming back, accompanied by a lot of pain and elbow tendonitis. It feels like my TFCC is about to tear again. My doctor said to stop climbing forever. Ha-ha, not likely! I lack a climbing-specific strengthening program to protect this area. I know how to build up my forearms, but it’s twisting the wrist that’s a problem, and I have no clue how to strengthen that movement. Is it horrible to keep climbing with torn ligaments? Should I take a lot of time off? Should I even bother getting it repaired again?

obhobie | Rock and Ice Forum


Stevie Haston once told me, with specific regard to his teenage daughter having her boyfriend stay over while the rest of the family was away on holiday, “Never tell somebody to do something if they are going to disobey you—it undermines your authority.” Golden words.

Now, your physician may not have been as intuitive as Mr. Haston, but it’s entirely possible he is correct in warning you away from climbing. I have several climbing patients who seem to fall apart at the slightest exertion. Why they bother is a testament to their love of the climber’s life. Tenacity, however, does not equate to anatomical wherewithal.

I would be surprised if you had torn the ligaments for a third time. Rather, it sounds like post-op/immobilization- related stiffness in your wrist, not a lack of strength or ligament injury, is causing most of the irritation. The sense of restriction and accompanying crackles result from your carpals articulating like the pistons of a seized engine.

I agree, you are on the cusp of re-injury, and if you blow it a third time you need to question the call to push your physical capacity through climbing. Not to climb seems rash, but the intensity with which you approach your training is clearly too much for your wrist at this point.

Step one: Get those joints loosened up. You need to look around for a therapist familiar with wrist injuries who is prepared to use some fairly firm articulation techniques. Most therapists will be conservative and will use gentle articulation — about as helpful as patting an angry polar bear.

Step two: Get someone to give you a “re-entry” strengthening program similar to the one I’ve outlined in Dodgy Elbows found at drjuliansaunders. com. Yours is not working!




When I stop drinking coffee, after four or five days I get really tight hamstrings and have to take painkillers to sleep. This lasts for a week or two and eventually goes away.

Nigel Campbell | Blue Mountains, Australia


Caffeine addiction is a very serious health concern that lacks public awareness. In fact, I am going to send a letter to the FDA suggesting that all coffee mugs carry a Black Box warning, along with the cautionary “hot liquid” for the categorically stupid.

Nigel, I am so glad you wrote in regarding your hamstrings, but I suspect it’s your innards that are the problem. You see, when you stop having coffee, your bum, or more accurately the plumbing that leads to your bum, misses caffeine like it was your left arm that’s been lost in the war. The morning call, whereby you urgently yet carefully do a waddle-skip-dipwaltz maneuver across the office/car park/mall/crag to the nearest port-a-potty/ bush/rock is silent. But the poop is still there.

After four or five days there is, as one of my friends so eloquently phrased it, “a cement truckload of sticky-ikky jammed up your tootie fruity.” I reckon that might be referring some pain to your hamstrings.

Fear not, there must be a help group out there. I recently saw one for lactating fathers, so constipation related to quitting caffeine cold turkey should be a shoe in with a little Googling. Perhaps there is an app that can help you? Or an app that can help you find someone in the near vicinity with the appropriate skills who might agree to help you.

Pain killers are but a band-aid. Some castor oil might be a more effective panacea. Or drink more water. Or try rubbing your tummy one way for two minutes and then in the reverse direction, turn around three times to the right, hail the Tao of Poo, and push like you are birthing a sea lion rather than a brown trout (contraindicated if you suffer hemorrhoids). Or maybe one of those cleansing thingies where they put a water pipe up your butt. Or maybe Scientology; those guys are full of it and don’t take any meds at all!


Booby trapped

The TFCC is basically a web of ligaments and the disc of cartilage they suspend that all sits between the carpal bones on the little finger side of your wrist and the end of the ulna (one of two bones in the forearm, the radius being on the opposing thumb side). The complex primarily has two roles: a) to cushion forces transmitted from the wrist to the forearm, and b), to both stabilize the wrist while increasing its functional range of motion. This is usually a sloper injury! That is, you keep falling off the hold affectionately known as “the boob” until your wrist hurts. The day after, it really hurts, and the day after that you start thinking about a ski holiday. Minor tears will typically settle after a few weeks. Larger tears or ligament rupture require surgery.