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Injuries and Medical Advice

A Doctor’s Guide to Your Climbing Body

A guide to common sites and causes of climbing wear and tear.

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Albeit the shoulder is called a ball-and-socket joint, it is more like a basketball-and-tea-saucer joint. Underpinning control is a finely tuned disaster-mitigation plan.

Rotator cuff tears

The rotor cuff is the group of muscles and tendons that stabilize the shoulder. The rotator cuff sounds like one thing, but it is really four muscles.

Diagnosing rotator-cuff tendon tears in a sore shoulder is like identifying egotism in politicians: nine times out of 10 you will be right.

More than any other area the musculature of the shoulder does well with a good warm-up and an ounce of intuition. If you think you might be hurting your shoulder, you probably are. Instead of trying to stick the gaston one more time, do something else.


The labrum is the socket of cartilage in which the ball of your armbone rests in your shoulder. Relatively common and debilitating, a labral tear can be a by product of another shoulder trauma such as a dislocation or torn rotator cuff, but it can be a stand alone and is one of the few good reasons for shoulder surgery. That said, more than two-thirds will settle with some tender, loving physical therapy.


The pain of a dislocated shoulder is not dissimilar to the demise of Fanny Mae and Freddie Mac-eye-opening-ly quick, accompanied by tornado-like damage. Fractures are common. Like a Russian sub, you won’t see it coming until carnage rains on your parade. On the other hand, if you have had a dislocated shoulder before, you live in fear of a repeat every time you brush your hair, let alone go near a cliff. Surgery is an ongoing experiment for which the general population is a willing guinea pig. You will have little choice if you suffer recurrent episodes and have tried stability-based exercises first. Subluxations (an “almost” dislocation) often precede the full monty and will feel like the joint shifted. Warning shot! Your shoulder is not strong enough to complete the move (usually something that puts your arm above your head and your shoulder in a horrible, twisted position) in a controlled fashion. Recalibrate the movement or get stronger. Shoulder stabilization programs using an exercise ball can be especially effective at reducing the risk of dislocation.


Medial epicondylosis

Most of the muscles that control finger and wrist flexion attach to the bony lump on the inside of your elbow via a common tendon. If this tendon is not capable of withstanding the forces generated by the muscles anchoring to it, the tendon becomes damaged and may develop into tendonosis. I see climbers with this ailment in epidemic proportions! Learn how to open hand. If your elbows are getting a little sore, minimize crimping. Some people will get away with behaving like Rick Perry with a six-shooter. Most will need to be slightly less gung ho. Open hand more. Crimp less.

Ulna collateral ligament (UCL) rupture

Ka-Pow! This one is like a bullet through the middle of your meditation class. For a moment you will refuse succumbing to this outward distraction. “It means nothing,” you will say. “It missed me!” you will chuckle. Oh-no-it-did-not-you-silly-git. The biggest blows are rarely painful in the moment. At T12 hours, you will know what I mean. Virtually every case I have seen has involved a lapsed climber returning to fitness or a strong boulderer getting pumped®and chicken winging. So, to avoid a UCL rupture, keep your elbows down. Contemptible advice from me, really, since I am a true flapper. I ruptured the left and right in the same year.


Tendon junction tear

Imagine your four fingers as they enter your palm are the four tendons (each controlling one finger) as they attach to the end of the muscle. If you leave one finger long and pull the others tight into your palm the tension between the tendons as they transition into the muscle is a little like the webbing between your fingers, but more so. Gently pull on that finger (especially the ring finger) while forcibly contracting the other fingers into your palm and feel the strain in your forearm!

This is actually the testing procedure if you think you may have injured this tissue. I am pushing the moniker of the “Dr. J Test” as I feel it is my only opportunity for academic recognition. But still no one has called from the Nobel Prize Institute. I guess they lost my mom’s nomination.

Rule number one: if you are pulling on one, two or even three fingers, do not pull the neighboring fingers tightly into your palm simultaneously.


Triangular fibro-cartilage complex (TFCC)

The TFCC is a small disc of cartilage that sits between the end of the ulna and the carpal bones on that side of the wrist. Climbers are prone to tearing it by virtue of large traction and shearing forces when pulling on large, round holds. Some people call them slopers. I call them voluptuous.

The worst thing you can do is to work a sloper problem over and over, or at least one particular move. Typically you don’t feel it in its full glory until the next day, but you always have an inkling that what you are doing is not right. If you have to give your wrist a “therapeutic” shake after an attempt-back off!



Synonymous with climbing, tears to the pulley apparatus are virtually unavoidable if you are vaguely pushing your limit. Taping as a prophylactic measure is pointless. The best avoidance strategies are to stretch your fingers often, warm up well (on a few moderates, as opposed to a hard route you have wired), minimize crimping, and be careful when splitting/overloading fingers on quirky holds.


Caused by sudden increases in training with regard to finger loading, e.g. campusing twice a week with no build up, stress fractures will have you sitting down for much longer than you’d like. Bones that are still growing are more susceptible to stress fractures. Parents, you are the ones with the brains, so at times you will need to be your kid’s handbrake. Pay attention: Pain in the shaft of a bone that worsens in any given session is a red flag. Ladies, you need to watch your calcium intake and in particular your menstrual cycle. A sporadic or absent cycle is a harbinger of bone trouble. When in doubt, eat little fish, bones an’ all!