[jstrongman]

Hi,

I had a left knee arthroscopy 2 weeks ago, which, removed a 1" by 1/2" radial tear of the meniscus. The swelling has pretty much gone and my range of movement and strength are probably 70%. I am following the standard set of physio exercises and some very light yoga, are there any additional exercises you could recommend before for returning to climbing.

Also how long should I leave it and/or what level should I be at before starting to climb again?

Thanks

James

[PeteHukb]

Hi nice physio people. I posted this RFI over on UKC but then spotted this thread and thought I'd ask you guys on your perspective, being less inclined to cutting and maiming than the average orthopod. Physio perspective much appreciated!

Basically I have a partial scapholunate ligament tear, diagnosed on MR arthogram, and am waiting to see my orthopaedic surgeon (an upper limb specialist), and I'm keen to be armed with a few alternative perspectives before I go see him.

I reckon (although I'm far from sure) that the original injury happened just over a year ago in Yosemite, probably torquing hard off a fist jam - it really wasn't that bad at the time, and I didn't lose any climbing time at all, but ever since my left wrist has felt a bit "loose" and unstable, particularly when doing open-handed hangs. In that year I've climbed as hard as I ever have and it's not really held me back.

About a month ago I did something else to it during an indoor wall session - not really sure what - but it was sore and stiff for about 5-7 days during which it was definitely impingeing on dressing/washing and my job. During that time I decided I'd better get it seen to in case it wasn't going to get better or in case I was putting my wrist at risk by ignoring it. Found a friendly orthopaedic surgeon (who is a hand/wrist specialist) and got myself a dynamic CT (fancy but not much use diagnostically) and, just today, an MR arthrogram, which has shown a partial scapholunate ligament tear.

Now, in the meantime my wrist is essentially back to how it's been since the original injury in Yosemite - not painful but a bit loose and wobbly, and I've had no problems going back to light training (including one-arm lock + lowers, static campus rung hangs, gentle bouldering). I can't do press ups (pain on wrist hyperextensions) but I've been doing tuck planches on clenched fists. So it's not like my wrist is really causing me much of a problem at the moment. My concern is that looking at the very varied literature around the place, there's a risk of progression of these injuries, and I certainly don't want to end up with an arthritic and useless wrist in a few years' time... But I also don't want arthroscopes, knives or bits of tendons (which may not stand up to further fist jams) stuck into my wrist unnecessarily. Hence the request for information.

Cheers for reading!

[HPclinic]

Hi,

I had a left knee arthroscopy 2 weeks ago, which, removed a 1" by 1/2" radial tear of the meniscus. The swelling has pretty much gone and my range of movement and strength are probably 70%. I am following the standard set of physio exercises and some very light yoga, are there any additional exercises you could recommend before for returning to climbing.

Also how long should I leave it and/or what level should I be at before starting to climb again?

Thanks

James

Hi James, in theory you have had the problem removed and as long as the effusion/swelling has reduced then you should be getting back to climbing again in a graduated way.
I would imagine you have had some time (at least 2 weeks) away from climbing so you will certainly need to climb at a lower grade, less volume and keep your sessions shorter. If you are getting muscular soreness then this is ok and would be expected after a duration away from climbing. If you have increased pain just back off on the volume and intensity. Basically gradually increase the volume and intensity in a controlled objective way.
If the physio exercises involve staic lunges and wall slides then these are similar to the type of movements your legs are doing when climbing ie weight transference on to the supporting leg and pushing through the knee and hips.
If you have any issues let me know, just increase the climbing in a steady controlled way. Good luck.
Matt

[jstrongman]

Hi James, in theory you have had the problem removed and as long as the effusion/swelling has reduced then you should be getting back to climbing again in a graduated way.
I would imagine you have had some time (at least 2 weeks) away from climbing so you will certainly need to climb at a lower grade, less volume and keep your sessions shorter. If you are getting muscular soreness then this is ok and would be expected after a duration away from climbing. If you have increased pain just back off on the volume and intensity. Basically gradually increase the volume and intensity in a controlled objective way.
If the physio exercises involve staic lunges and wall slides then these are similar to the type of movements your legs are doing when climbing ie weight transference on to the supporting leg and pushing through the knee and hips.
If you have any issues let me know, just increase the climbing in a steady controlled way. Good luck.
Matt

Great thank you Matt, I will slowly build it up. I was just worried about squashing (landing on it) or twisting too much while it is still healing (or is there nothing to heal and it is just about getting the supporting strength back into the leg)  I suppose climbing more straight on wouldn't hurt in building some strength anyway.

Thanks again

James

[HPclinic]

Hi nice physio people. I posted this RFI over on UKC but then spotted this thread and thought I'd ask you guys on your perspective, being less inclined to cutting and maiming than the average orthopod. Physio perspective much appreciated!

Basically I have a partial scapholunate ligament tear, diagnosed on MR arthogram, and am waiting to see my orthopaedic surgeon (an upper limb specialist), and I'm keen to be armed with a few alternative perspectives before I go see him.

I reckon (although I'm far from sure) that the original injury happened just over a year ago in Yosemite, probably torquing hard off a fist jam - it really wasn't that bad at the time, and I didn't lose any climbing time at all, but ever since my left wrist has felt a bit "loose" and unstable, particularly when doing open-handed hangs. In that year I've climbed as hard as I ever have and it's not really held me back.

About a month ago I did something else to it during an indoor wall session - not really sure what - but it was sore and stiff for about 5-7 days during which it was definitely impingeing on dressing/washing and my job. During that time I decided I'd better get it seen to in case it wasn't going to get better or in case I was putting my wrist at risk by ignoring it. Found a friendly orthopaedic surgeon (who is a hand/wrist specialist) and got myself a dynamic CT (fancy but not much use diagnostically) and, just today, an MR arthrogram, which has shown a partial scapholunate ligament tear.

Now, in the meantime my wrist is essentially back to how it's been since the original injury in Yosemite - not painful but a bit loose and wobbly, and I've had no problems going back to light training (including one-arm lock + lowers, static campus rung hangs, gentle bouldering). I can't do press ups (pain on wrist hyperextensions) but I've been doing tuck planches on clenched fists. So it's not like my wrist is really causing me much of a problem at the moment. My concern is that looking at the very varied literature around the place, there's a risk of progression of these injuries, and I certainly don't want to end up with an arthritic and useless years' time... But I also don't want arthroscopes, knives or bits of tendons (which may not stand up to further fist jams) stuck into my wrist unnecessarily. Hence the request for information.

Cheers for reading!

Hi Pete, this is a very debatable subject of whether you should continue conservatively or go along the surgical route.
Interestingly your dynamic CT didn't show any abnormal gapping or positional changes which you would probably  expect from a full rupture. A partial tear could mean that the majority of the ligament is still intact and this may be why you can still climb at a good level. There are also 3 different parts to this ligament and some are more structurally important.
With regards to arthritic changes the literature doesn't really support this and we often find similar myths/anecdotal information is given to patients following other ligament injuries such as the cruciate ligaments in the knees, again the literature on correlating arthritic changes with ligaments injuries isn't conclusive. One study for example followed up on patients 7 years after a scapholunate ligament injury and found no arthritic changes. The internet is a fantastic source of info. but take care because some of the information scares people and isn't backed up with scientific evidence.
Have you tried using wrist tape or supports and if so does this make a difference?
Personally if you are gradually loading the wrist and slowly returning to your previous grades then i would continue conservatively unless the pain increases and you are no longer able to climb. If wrist extension when loaded is sore ie when doing a press up then continue to use your fists or not do them. I feel that a press up isn't similar to any climb moves or positions and there are plenty of other exercises to compliment your climbing.
Perhaps still see the surgeon and discuss the options as ultimately it is your decision.
We are also assuming that the ligament is the problem and sometimes this is the red herring i.e, it was already injured but asymptomatic!!
Hope this helps and if you are local to Sheffield perhaps book an appointment for a more thorough look.
Regards
Matt

Hi James, in theory you have had the problem removed and as long as the effusion/swelling has reduced then you should be getting back to climbing again in a graduated way.
I would imagine you have had some time (at least 2 weeks) away from climbing so you will certainly need to climb at a lower grade, less volume and keep your sessions shorter. If you are getting muscular soreness then this is ok and would be expected after a duration away from climbing. If you have increased pain just back off on the volume and intensity. Basically gradually increase the volume and intensity in a controlled objective way.
If the physio exercises involve staic lunges and wall slides then these are similar to the type of movements your legs are doing when climbing ie weight transference on to the supporting leg and pushing through the knee and hips.
If you have any issues let me know, just increase the climbing in a steady controlled way. Good luck.
Matt

Great thank you Matt, I will slowly build it up. I was just worried about squashing (landing on it) or twisting too much while it is still healing (or is there nothing to heal and it is just about getting the supporting strength back into the leg)  I suppose climbing more straight on wouldn't hurt in building some strength anyway.

Thanks again

James

Hi James, the menicus has been trimmed and the offending tear will no longer be causing a mechnical problem. Cartilidge likes to be compressed (but not overloaded). You will have some muscle inhibition and weakness but getting back to exercise will help to return the equilibrium and control around the knee.
Matt

[PeteHukb]

Hi Matt,
Thanks for that, that's really helpful. Have you got a reference for that 7 year study? That's exactly the sort of info I'm looking for really and didn't come across it searching. I'm a doctor and I've got an Athens password (although Google Scholar's usually more helpful...)

Yeah I'm not convinced the dynamic CT was done in the best way... I gather they've only just started doing them at my hospital, and, since I emphasised that there was a definite "clunk" only on specific loading (resisting passive ulnar deviation from neutral), they gamely set up a big water bottle in the scanner for me to push my hand against, but with the weirdness of the set-up - lying on my front in the Superman position etc - and maybe some performance anxiety, I couldn't make it happen. It didn't show any major gapping or subluxation, but it certainly feels + looks to me like my lunate's clunking dorsally when I do that specific movement.

The MR report says it's the volar fibres which are torn, if that helps. I understand the dorsal ones are probably more important. I've had a look at the images myself and it does, for what it's worth, look like a really tiny leak of contrast compared to the examples (mostly full ruptures) I've seen on the internet. So I guess that's good!

I haven't tried any taping or supports - not really sure where to start, which I guess is where I might need a physio! As for the press-ups, I tend to use the tuck planches as an all-round antagonist exercise for triceps, rotator cuff and for some core, but I will indeed keep a close eye, and if I think it's causing me issues I'll drop it happily.

I'm also glad you've mentioned the red herring possibility - I certainly wondered this, both my wrists are pretty hypermobile to be honest and I'm not totally convinced it's the whole story.

Unfortunately I'm not in Sheffield... I'm based in Bradford at the moment, and if you had any recommendations for sports physio people more local to me, particularly any who are used to dealing with (and sympathetic to!) climbers, I'd really appreciate that.

Pete.

[erm, sam]

Unfortunately I'm not in Sheffield... I'm based in Bradford at the moment,

Fuck it, drive to Sheff. Its not that far from Bradford. I have driven over from Manchester to see Alison back in the day and never felt it was too much trouble.

[Sasquatch]

For the last 3-4 weeks I've had an off and on soreness/pain/swelling in my left middle finger near the DIP joint.  The sensitivity seems to be on the top and sides of the DIP joint towards to fingertip.  I don't recall doing anything specific to injure it, and can't seem to pinpoint what makes it sore, so I've just continued traning/climbing on it.  However, It has now gotten a bit more consistant, but I still can't figure out any triggers or causes.  Any Ideas?

Thanks,
Todd

Any thoughts on the finger.  I'm happy to give more details as I'm stumped....

[Sasquatch]

For the last 3-4 weeks I've had an off and on soreness/pain/swelling in my left middle finger near the DIP joint.  The sensitivity seems to be on the top and sides of the DIP joint towards to fingertip.  I don't recall doing anything specific to injure it, and can't seem to pinpoint what makes it sore, so I've just continued traning/climbing on it.  However, It has now gotten a bit more consistant, but I still can't figure out any triggers or causes.  Any Ideas?

Thanks,
Todd

Any thoughts on the finger.  I'm happy to give more details as I'm stumped....

It would appear that crimping is what does it, open/sloper/[pockets are fine.  It almost seems as though it something being compressed on the fingernail side of the finger when the DIP joint flexes back during crimping.

[Concretesnail]

Not sure how I've done it but I have managed somehow to injure myself. I'm not sure what I've done or exactly what to call it so I'm looking for some advice as to what I may have done and any help advise as to stretches or exercise which could help relieve it.

Symptoms
Numbness in my hand; across the back and in in the palm.
Numbness in fingers and thumb; mostly the thumb and back two
Pain in the forearm; in the area just shy of the elbow
Pain in the upper arm; just round the outside of the elbow, though it hasn't risen higher at all.

[slackline]

 

[Evil]

Hope you can offer some advice. Hopefully I've given enough info without making it way too long!

Background: I dislocated my elbow back in February this year, it was quite a bad dislocation, but there were no fractures. I had it reduced at A&E, had it cast, which I asked to be removed completely after 9 days (they wanted to cast it for at least 3 weeks). It healed quite well (certainly much better than the doctors seemed to think it would), I have not far off complete range of motion back. The missing part seems to be in bending it rather than straightening it, though it no longer hyper-extends like my other elbow does. I did have an electrical test on the ulna nerve as my arm went to sleep when I was asleep/lying down for quite a long time after the injury, but it was found to be ok, and I no longer have this problem. When I bend my arm, the knobbly bit on the inside of the elbow is more prominent on the dislocated one than the other one, and this is quite close to where it hurts (just a bit further round).

I now find when climbing that arm gets really pumped compared to the other one, and after doing routes last night and getting very pumped, it was a bit painful at the time, and really painful when I woke up this morning. It's not actually in the elbow joint that's sore, but at the back of my arm just above it, and I can't really work out what it is/what I could do to make it better. Most of the literature on elbow dislocations focus on returning ROM and the joint itself (which seems to be fine and I have no problems campussing, bouldering quite hard (for me), doing pullups etc.  ). I'd also love to not get so pumped in that arm. I did think it might be getting pumped more because it does not totally straighten so I'm not hanging on a completely straight arm in between moves, but I'm not sure that explains it (what with the pain at the back of my arm).

[SEDur]

Hi Guys,
Just wondering if you have some good advice for a problem I've been having.

I sprained (type 2 i think the physio said) my ankle in February.
Saw the physio, got it loosened up. Damaged it the next day slipping on a wet floor.
But carried on with the ice and exercises until they became fairly easy, so for 2 or so months with a little easy low-load climbing after the first month; subsequently increasing the load to normal by May time and pushing through over summer.

I noticed that when I walk through particularly cold areas (even over a short period of time), my knee and ankle on that side get stiff. I have also started jogging/running doing hill reps on grass for half an hour at a time. Needless to say both my ankle and knee flare up if i run down the hill; but i also find that if I really run fast up the hill, then my knee and ankle start to hurt and the gate of my step seems to get wider and my foot starts to point further outwards. By this point its normally been half an hour and I drag myself back home for a stretch and hot shower.

Would that suggest that one specific muscle set is weak? Should I try and exercise my leg and calf muscles more?

Cheers!

[nasher47]

Hi Guys,

Tried out a new core workout on Tuesday morning and it was fairly hard. I was fine all day Tuesday but then since yesterday (Wednesday) I've been getting a quite severe pain on the front of my hips everytime I'm stood up straight. It's hasn't eased off at all today even after an hour of yoga. Any suggestions as to what this might be and what I should do to help it calm down?

Cheers!

[HPclinic]

Hi Matt,
Thanks for that, that's really helpful. Have you got a reference for that 7 year study? That's exactly the sort of info I'm looking for really and didn't come across it searching. I'm a doctor and I've got an Athens password (although Google Scholar's usually more helpful...)

Yeah I'm not convinced the dynamic CT was done in the best way... I gather they've only just started doing them at my hospital, and, since I emphasised that there was a definite "clunk" only on specific loading (resisting passive ulnar deviation from neutral), they gamely set up a big water bottle in the scanner for me to push my hand against, but with the weirdness of the set-up - lying on my front in the Superman position etc - and maybe some performance anxiety, I couldn't make it happen. It didn't show any major gapping or subluxation, but it certainly feels + looks to me like my lunate's clunking dorsally when I do that specific movement.

The MR report says it's the volar fibres which are torn, if that helps. I understand the dorsal ones are probably more important. I've had a look at the images myself and it does, for what it's worth, look like a really tiny leak of contrast compared to the examples (mostly full ruptures) I've seen on the internet. So I guess that's good!

I haven't tried any taping or supports - not really sure where to start, which I guess is where I might need a physio! As for the press-ups, I tend to use the tuck planches as an all-round antagonist exercise for triceps, rotator cuff and for some core, but I will indeed keep a close eye, and if I think it's causing me issues I'll drop it happily.

I'm also glad you've mentioned the red herring possibility - I certainly wondered this, both my wrists are pretty hypermobile to be honest and I'm not totally convinced it's the whole story.

Unfortunately I'm not in Sheffield... I'm based in Bradford at the moment, and if you had any recommendations for sports physio people more local to me, particularly any who are used to dealing with (and sympathetic to!) climbers, I'd really appreciate that.

Pete.

Hi Pete the ref is ....O’Meeghan et al 2003. The Natural History of an Untreated Isolated Scapholunate Interosseus Ligament Injury. J Hand Surg Eur Vol August 2003 vol. 28 no. 4 307-310
I unfortunately don't know any sports physios in the Bradford area, but i will ask my colleagues.
You mentioned your wrists are hypermobile so controlling the amount of movement is probably more important ie avoid excessive end range movements and positions. It makes sense that you get pain with pressups because you will probably be at end range of extension with additional load.
Interestingly you may find that you have always had a small scapholunate tear and this may be a common thing with climbers, particularly if you are hypermobile?
You are also correct in that the dorsal part of the ligament is the most important.
Try a wide sports tape around your wrist that will go either side of the joint line between carpals and radias/ulnar. You could experiment with rigid tape or the more current/ popular rock tape that has more elastic properties.
Let me know how you get on.
Regards
Matt

[Charlton Chestwig]

Hello Physio peeps,

I've had some shoulder impingement in the past and I think it might have crept back in after a session at the wall where I did an odd shouldery move. Afterwards I had a very slight niggle on the back of my shoulder (sort of inside the shoulder-blade). As it wasn't much of note I've since had about 3-4 training sessions and during the last of these I decided it had got worse and stopped as a result. That was yesterday.

Does this sound like a regular shoulder impingement to you; such that I would do active rest, ice, ibuprofen and the usual exercises. Or is it worth seeking out some hands on assessment?

Also does any other treatment (such as massage/needles) actually help with recovery or is this just witchcraft?

Cheers,

Rich

[HPclinic]

For the last 3-4 weeks I've had an off and on soreness/pain/swelling in my left middle finger near the DIP joint.  The sensitivity seems to be on the top and sides of the DIP joint towards to fingertip.  I don't recall doing anything specific to injure it, and can't seem to pinpoint what makes it sore, so I've just continued traning/climbing on it.  However, It has now gotten a bit more consistant, but I still can't figure out any triggers or causes.  Any Ideas?

Thanks,
Todd

Any thoughts on the finger.  I'm happy to give more details as I'm stumped....

It would appear that crimping is what does it, open/sloper/[pockets are fine.  It almost seems as though it something being compressed on the fingernail side of the finger when the DIP joint flexes back during crimping.

Hi Todd,
it sounds like it could be an A5 pulley irritation. This pulley is located on the distal DIP joint. As you may know the more common pulley to injury is the A2 but any of the pulleys can be strained or overloaded. The open crimp puts a large load on all of the pulleys. I would back off the crimping and go for the bigger holds as it is important to still put stress through the tendons and pulleys but not to overload them and cause microtrauma cumulative strains. Basically if you can climb with only mild discomfort then this is ok but don't climb through pain and you shouldn't have a lot of stiffness the next day.
To progress back to crimping start to introduce the odd move and see how it feels. If it is painful do less, if it is ok add a few more moves.  You need to have a base that is pain free and move forward and progress the good stresses of climbing to the tendons. Let the tissues adapt but don't overload.
Regards
Matt

[HPclinic]

Not sure how I've done it but I have managed somehow to injure myself. I'm not sure what I've done or exactly what to call it so I'm looking for some advice as to what I may have done and any help advise as to stretches or exercise which could help relieve it.

Symptoms
Numbness in my hand; across the back and in in the palm.
Numbness in fingers and thumb; mostly the thumb and back two
Pain in the forearm; in the area just shy of the elbow
Pain in the upper arm; just round the outside of the elbow, though it hasn't risen higher at all.

Hi, it sounds like you have irritated a nerve in your neck. The symptoms are specific to a certain level. It has probably occured over a period of time and doesn't have to be a specific incident. It is often related to sustained sitting positions with a poor posture and a lack of movement. If you are mainly sitting in the daytime at a computer then regularly change position to break up prolonged positions particularly if they are slumped. I would reccomend you see a local physio for a thorough examination as the symptoms can hang around and you need to know how to best manage them.
Regards
Matt

[HPclinic]

Hope you can offer some advice. Hopefully I've given enough info without making it way too long!

Background: I dislocated my elbow back in February this year, it was quite a bad dislocation, but there were no fractures. I had it reduced at A&E, had it cast, which I asked to be removed completely after 9 days (they wanted to cast it for at least 3 weeks). It healed quite well (certainly much better than the doctors seemed to think it would), I have not far off complete range of motion back. The missing part seems to be in bending it rather than straightening it, though it no longer hyper-extends like my other elbow does. I did have an electrical test on the ulna nerve as my arm went to sleep when I was asleep/lying down for quite a long time after the injury, but it was found to be ok, and I no longer have this problem. When I bend my arm, the knobbly bit on the inside of the elbow is more prominent on the dislocated one than the other one, and this is quite close to where it hurts (just a bit further round).

I now find when climbing that arm gets really pumped compared to the other one, and after doing routes last night and getting very pumped, it was a bit painful at the time, and really painful when I woke up this morning. It's not actually in the elbow joint that's sore, but at the back of my arm just above it, and I can't really work out what it is/what I could do to make it better. Most of the literature on elbow dislocations focus on returning ROM and the joint itself (which seems to be fine and I have no problems campussing, bouldering quite hard (for me), doing pullups etc.  ). I'd also love to not get so pumped in that arm. I did think it might be getting pumped more because it does not totally straighten so I'm not hanging on a completely straight arm in between moves, but I'm not sure that explains it (what with the pain at the back of my arm).

Hi, you sound like you are doing very well and you have a good range of movement. Often regaining full elbow extension can be a problem. You have regained this and it isn't a bad thing that it no longer hyperextends. Although the ulnar nerve has recovered you may still have some sensitivity with it. Often with dislocations at any joint the nerves can be overstretched.
Try testing how the ulnar nerve moves by comparing sides. To begin, stretch your arm out to the side and have your fingers pointing towards the celing, palm facing outwards, then bend your elbow and continue to move your fingers towards your face (thumb facing forward) until your fingers are on your cheek pointing downwards. You may get a normal pulling sensation. Compare to the other side. If it is more uncomfortable or the discomfort doesn't allow you to do the full movement then it is more sensitive. I would google ulnar nerve mobilsation exercises and try these.
The fact that your arm is getting more pumped is probably because you are still lacking some strength and it won't just be your forarm muscles, all of the left arm will have become weaker and may not have been fully addressed. This lack of global strength may be putting more of a stress through the elbow and this may be the source of the problem.
I would expect a degree of discomfort for up to a year following this kind of injury. You may benefit from a physio review specific to climbing.
Regards
Matt

[HPclinic]

Hi Guys,
Just wondering if you have some good advice for a problem I've been having.

I sprained (type 2 i think the physio said) my ankle in February.
Saw the physio, got it loosened up. Damaged it the next day slipping on a wet floor.
But carried on with the ice and exercises until they became fairly easy, so for 2 or so months with a little easy low-load climbing after the first month; subsequently increasing the load to normal by May time and pushing through over summer.

I noticed that when I walk through particularly cold areas (even over a short period of time), my knee and ankle on that side get stiff. I have also started jogging/running doing hill reps on grass for half an hour at a time. Needless to say both my ankle and knee flare up if i run down the hill; but i also find that if I really run fast up the hill, then my knee and ankle start to hurt and the gate of my step seems to get wider and my foot starts to point further outwards. By this point its normally been half an hour and I drag myself back home for a stretch and hot shower.

Would that suggest that one specific muscle set is weak? Should I try and exercise my leg and calf muscles more?

Cheers!

Hi, We often see chronic ankle injuries and the most common presentations are that the ankle is still lacking dorsiflexion (foot moving towards shin such as in a lunge position) in weight bearing and there is a loss in dynamic ankle activity such as jumping or hopping. If you are experiencing knee and ankle pain it sounds as if your ankle may not have regained full movement and you are compressing the joint as well as the knee having to compensate for this restriction. Up and down hills will be worse.
The range of movement needs to be tested in weight bearing as you don't always see it when just moving the ankle. To test and compare sides start on the good leg, with your toes against a wall you should be able to easily bend your knee and touch the wall also. Slowly slide your foot back in increments until you have to lift your heel. This is the weight bearing range of ankle dorsiflexion. Compare to the symptom side.
Also try and hop as high as you can on either leg and see if there is a difference.
See how that goes and you may need to get some help if the joint is still restricted.
Regards
Matt

[HPclinic]

Hi Guys,
Just wondering if you have some good advice for a problem I've been having.

I sprained (type 2 i think the physio said) my ankle in February.
Saw the physio, got it loosened up. Damaged it the next day slipping on a wet floor.
But carried on with the ice and exercises until they became fairly easy, so for 2 or so months with a little easy low-load climbing after the first month; subsequently increasing the load to normal by May time and pushing through over summer.

I noticed that when I walk through particularly cold areas (even over a short period of time), my knee and ankle on that side get stiff. I have also started jogging/running doing hill reps on grass for half an hour at a time. Needless to say both my ankle and knee flare up if i run down the hill; but i also find that if I really run fast up the hill, then my knee and ankle start to hurt and the gate of my step seems to get wider and my foot starts to point further outwards. By this point its normally been half an hour and I drag myself back home for a stretch and hot shower.

Would that suggest that one specific muscle set is weak? Should I try and exercise my leg and calf muscles more?

Cheers!

Hi, We often see chronic ankle injuries and the most common presentations are that the ankle is still lacking dorsiflexion (foot moving towards shin such as in a lunge position) in weight bearing and there is a loss in dynamic ankle activity such as jumping or hopping. If you are experiencing knee and ankle pain it sounds as if your ankle may not have regained full movement and you are compressing the joint as well as the knee having to compensate for this restriction. Up and down hills will be worse.
The range of movement needs to be tested in weight bearing as you don't always see it when just moving the ankle. To test and compare sides start on the good leg, with your toes against a wall you should be able to easily bend your knee and touch the wall also. Slowly slide your foot back in increments until you have to lift your heel. This is the weight bearing range of ankle dorsiflexion. Compare to the symptom side.
Also try and hop as high as you can on either leg and see if there is a difference.
See how that goes and you may need to get some help if the joint is still restricted.
Regards
Matt

[HPclinic]

Hi Guys,

Tried out a new core workout on Tuesday morning and it was fairly hard. I was fine all day Tuesday but then since yesterday (Wednesday) I've been getting a quite severe pain on the front of my hips everytime I'm stood up straight. It's hasn't eased off at all today even after an hour of yoga. Any suggestions as to what this might be and what I should do to help it calm down?

Cheers!

Hi, sounds like you are getting DOMS (delayed onset muscle soreness) which is a normal muscular response to new or excessive loading of the muscles and usually occurs 24-48hrs after (hence the delayed). If you were doing a lot of core type exercises then you may have been compensating with your hip flexors (deep and in front of the hips) as opposed to your abdominals. For instance if you do a sit up then the abdominals often initiate the movement but the hip flexors will continue to pull you forward to your knees. Don't go mad with core exercises as the most important thing is to be strong and controlled through movement and not become to ridged.
Let me know if it doesn't settle.
Regards
Matt

[HPclinic]

Hello Physio peeps,

I've had some shoulder impingement in the past and I think it might have crept back in after a session at the wall where I did an odd shouldery move. Afterwards I had a very slight niggle on the back of my shoulder (sort of inside the shoulder-blade). As it wasn't much of note I've since had about 3-4 training sessions and during the last of these I decided it had got worse and stopped as a result. That was yesterday.

Does this sound like a regular shoulder impingement to you; such that I would do active rest, ice, ibuprofen and the usual exercises. Or is it worth seeking out some hands on assessment?

Also does any other treatment (such as massage/needles) actually help with recovery or is this just witchcraft?

Cheers,

Rich

Hi Rich, if it is near to the shoulder blade then it could be that you have irritated a thoracic joint or even where the rib attaches to the spine. Characteristically the pain is usually quite sharp and may benefit from ibuprofen. Normally they settle with movements of the shoulder, neck and upper back relatively quickly.
If your shoulder is impinging then you will find movements of the arm will be painful sometimes around shoulder height (approx 90 degrees). If it is sore then check to see if your shoulders are at different levels, ie is the symptomatic shoulder depressed. If so then this can lead to a mechanical impingment. Too much load or intense bouldering may have lead to this also. You could try backing of the grades and volume of climbing and see if this is tolerable. Progress as symptoms allow (some discomfort is exceptable but not pain . If it contiues get a review from a physio as rest alone isn't enough.
Regards
Matt

[Evil]

Hi, you sound like you are doing very well and you have a good range of movement. Often regaining full elbow extension can be a problem. You have regained this and it isn't a bad thing that it no longer hyperextends. Although the ulnar nerve has recovered you may still have some sensitivity with it. Often with dislocations at any joint the nerves can be overstretched.
Try testing how the ulnar nerve moves by comparing sides. To begin, stretch your arm out to the side and have your fingers pointing towards the celing, palm facing outwards, then bend your elbow and continue to move your fingers towards your face (thumb facing forward) until your fingers are on your cheek pointing downwards. You may get a normal pulling sensation. Compare to the other side. If it is more uncomfortable or the discomfort doesn't allow you to do the full movement then it is more sensitive. I would google ulnar nerve mobilsation exercises and try these.
The fact that your arm is getting more pumped is probably because you are still lacking some strength and it won't just be your forarm muscles, all of the left arm will have become weaker and may not have been fully addressed. This lack of global strength may be putting more of a stress through the elbow and this may be the source of the problem.
I would expect a degree of discomfort for up to a year following this kind of injury. You may benefit from a physio review specific to climbing.
Regards
Matt

Yeah, I feel a lot of tension in the back of the elbow when it's bent, so probably the ulnar nerve exercises will help, thanks. Not sure how much strength I actually lost though, as I was only not climbing for 7 weeks end of Feb, all of March, beginning of April. I hadn't really considered seeing a physio again (after the NHS one ran out), but it probably would be a good idea in the new year.
Thanks again.

[Sasquatch]

For the last 3-4 weeks I've had an off and on soreness/pain/swelling in my left middle finger near the DIP joint.  The sensitivity seems to be on the top and sides of the DIP joint towards to fingertip.  I don't recall doing anything specific to injure it, and can't seem to pinpoint what makes it sore, so I've just continued traning/climbing on it.  However, It has now gotten a bit more consistant, but I still can't figure out any triggers or causes.  Any Ideas?

Thanks,
Todd

Any thoughts on the finger.  I'm happy to give more details as I'm stumped....

It would appear that crimping is what does it, open/sloper/[pockets are fine.  It almost seems as though it something being compressed on the fingernail side of the finger when the DIP joint flexes back during crimping.

Hi Todd,
it sounds like it could be an A5 pulley irritation. This pulley is located on the distal DIP joint. As you may know the more common pulley to injury is the A2 but any of the pulleys can be strained or overloaded. The open crimp puts a large load on all of the pulleys. I would back off the crimping and go for the bigger holds as it is important to still put stress through the tendons and pulleys but not to overload them and cause microtrauma cumulative strains. Basically if you can climb with only mild discomfort then this is ok but don't climb through pain and you shouldn't have a lot of stiffness the next day.
To progress back to crimping start to introduce the odd move and see how it feels. If it is painful do less, if it is ok add a few more moves.  You need to have a base that is pain free and move forward and progress the good stresses of climbing to the tendons. Let the tissues adapt but don't overload.
Regards
Matt

Thanks!

"Basically if you can climb with only mild discomfort then this is ok but don't climb through pain and you shouldn't have a lot of stiffness the next day. "

So this is what's odd.  It never hurts to climb on it, or even when fingerboarding on it. When crimping it feels weak and After crimping hard it hurts, but never while doing it.  It's afterward and the next day that it's swollen and/or sensitive.  Massage really seems to help.  Anyway, I'll take it easy on the crimping for a while and see if it goes away.