Should I get laser eye surgery (if I'm planning to climb at altitude)? [back to top] [FAQ contents]

From: Kai Larson

In "Into Thin Air", Krakauer mentions that one of the climbers who'd had laser surgery went blind because the change in air pressure to altitude.

That is a different procedure. The guy who went blind had radial keratotemy. That procedure involves making radial cuts in the eye ball, which lengthen the eye.

Almost no one has this procedure done any more.

LASIK involves cutting a flap of tissue away from the cornea and sculpting the corneal lens with a laser. It works on a very different principle than rk.

From: Robert Jones

The cornea is on average is 500 microns thick in the center. RK cuts 90% of this thickness and never heals as strong. The eye will lyse at 50% less pressure than a normal eye.

With Lasik a flap of around 120 microns is made and replaced. No cutting into deeper layers is done. A 6.5 mm zone is ablated at 12 microns per dipoter (For Visix Star lasers). It depends on the starting prescription but around 100 microns (1/5) is tissue is removed from the center of the conea and much less near the periphery of the 6.5 mm zone. No tissue is removed on the other 5 mm of the cornea. Corneal stabilty is superior than a post op RK eye.

PRK is similar to LASIK but no flap is made.

Of the available surgeries PRK would be the most stable at high altitudes followed closely by LASIK, RK is a very distant third. DON'T have RK done.

There may more corneal changes at altitude vs a normal eye. But the amount of myopia induced is probably minimal. The amount of myopia would vary with each individual. One person may have zero problems at high altitudes but another with a thinner post operative cornea may experiece some myopic shift.

From: rick++

Doctors are supposed to give have you sign a form being aware of complications.
Lasik has 85% improvement on the first procedure.
15% either require a second procedure, have no improvement, or a 3% unreapairable deterioration.
The one in six second procedure rate is why it is not recommended to go to Canada to save money.

So are you willing to risk damaging your vision for 1 in 30 chance in order to improve your vision in a 9 in 10 chance?
Everyone has to make their own decision.

From: Ken Purcell

Make sure and ask about "Dry Eye Syndrome". They forgot to mention that to me. I had to take gui drops for 6 months. I still have the odd problem. As we know, its usually quite dry up High!

From: Kai Larson

After more than a year of deliberation and watching the technology change and improve, I had my eyes lasered last month. I got glasses in first grade. I wore contact lenses during high school and college, but my eyes kept developing problems (dry eyes, discharge, etc.) , which finally led me to abandon contacts. I tried several of the new ultra-permeable contact lenses in the last year, with the same bad results.

So I finally got my eyes lasered. It was by far the most frightening decision I have ever made. So far, the results have been astoundingly good. I now have 20/20 visionin my right eye, and 20/25 vision in my left eye. My vision stabilized within 48 hours of the surgery. Healing has gone well. I don't know (nor does anyone) what the long term effects will be, but so far I am very very happy.

My eyes are in many ways more comfortable after the surgery than before. This is in part because I also had one tear duct on each eye (one of the ones that removes tears) plugged. This procedure causes your eyes to stay more wet. I've suffered from dry eyes all my adult life, and my eyes are now more comfortable than they were. The procedure is reversible, painless, and takes about 30 seconds. (the doctor just taps a little plug into your tear duct while sitting in the chair.)

I just got back from a climbing/skiing trip to the French Alps. My high point was 3885 meters. It was cold, windy, snowy. I had no problems at all with my eye sight. After thirty years of needing glasses or contact lenses, it was amazing. On the pre-dawn approaches, I didn't need to wear glasses at all, and when sun or snow required eye protection, I could use normal sunglasses or goggles. I did not experience the kind of fogging and vision interference that I usually suffered when climbing and skiing in cold weather with my glasses. Some of my most frustrating climbing memories have been trying to cope with fogged up glasses while climbing. In fact, ice-climbing blind (due to constanty fogged up glasses) on a pre-dawn alpine climb last Fall was one of the factors that made me take the scary plunge and get my eyes lasered.

The other major factor which led me to finally get my eyes lasered was the approval of the new Bausch and Lomb laser. There are two benefits to the Bausch and Lomb compared with earlier technology: First is that it allows for sculpting of a larger lens surface area. This was a decisive factor for me, because I have larger than average size pupils, so I needed to maximize the amount of lens that got sculpted. Many of the nasty complications (blurred peripheral vision, and particularly night vision issues) are associated with large pupil size relative to the size of the sculpted lens. You need to make sure that the entire surface of the lens your pupil allows you to see through is corrected. Otherwise, there will be a blurred ring around the edges of your vision. The larger your pupil (i.e. at night) the worse the fall-off.

The other improvement of the B&L laser is that it makes micro-corrections while cutting, adjusting to the tiny involuntary movements of your eye during surgery.

The B&L laser just got FDA approval in February. (Note: this post was made on 4/2000)

I have been watching the evolution of vision correction surgery for quite some time. I work in the pharmaceutical/medical device industry, so it is relatively easy for me to get information regarding the latest advances and future technology. (Lots of good information available at the H&Q conferences, for example.)

The interesting new advance that is not too far off is the integration of the surgical laser with the eye-mapping technology, for surgery that is truly customized to your eye shape.

Currently, surgeons have the ability to do a scan and map your cornea, ("orb-scan" is the most widely used such device), but the information gained in the mapping process is not integrated into the surgical procedure. In the next 12 to 18 months (some say more like 2 years), the corneal mapper will get linked to the laser, so the laser will perform its cutting based on your individual corneal shape.

I am blessed with a very average and regular corneal curvature, so this technology was not as relevant to my situation, but for the many people who have corneal shapes which deviate from the norm, this new technology might be worht waiting for.

If you are looking into getting surgery done, be sure to investigate exactly what equipment your surgeon is using. Significant advances are being made every year (or even 1/2 year), so make sure you take advantage of new technology.

Some of the major factors which cause differences in results are:

Pupil size: Make sure the laser used is capable of sculpting an area large enough to avoid peripheral distortion. Some people with extra large pupils simply can't have the surgery done.

Corneal shape: Currently, mapping technology can tell you if your corneal shape is normal, abnormal, etc. and let you know if you are a good candidate for surgery under the current technology. New technology (1 to 2 years away) will allow for better effectiveness with a broader range of corneal shapes

Eye movement: Newer lasers are designed to compensate for involuntary eye movement during surgery. (Although there are some proponents of "wide beam" lasers that discount the negative effect of involuntary eye movement)

Skill: The skill of the surgeon is clearly one of the most important factors. Getting a clean cut with the keratome is very important, as is the experience and honesty to give you a candid evaluation of whether or not you are a good candidate for surgery. Find out, at a minimum, pupil size, corneal shape, and corneal thickness and discuss these factors with the doctor. These are some of the main factors that go into deciding whether to have surgery or not. I know of some people who went to Canada to have eye surgery so they could save money. I looked around for the absolutely most experienced doctor, with the latest equipment. He was also the most expensive, and unlike some other doctors in the area, my insurance wouldn't cover any portion of the cost. This was one decision where cost didn't even figure into the equation for me, however. If I couldn't have afforded it, I would have waited and saved my money until I could, rather than looking for a bargain.

For a link to the place where I got my surgery done, go to:

http://www.discoverlasik.com

There is a fair amount of usefull information there, including information regarding the clinical trial results on the newly approved Bausch and Lomb laser.

From: David Van Baak

He claims . . .that the new generation techniques don't have many of the problems of older versions.

Isn't it interesting that each successive technique always makes this claim about all the earlier ones? If I had a collection of spare eyes, I might experiment with some of them; but as I don't, I won't.

See also:

Laser Vision Correction FAQ from TLC Laser Eye Centers
Lasik Institute
Mountain Climbers Who Have Had LASIK Should Be Aware of Possible Changes In Vision from The American Academy of Ophthalmology

Should I wear contact lenses or glasses at altitude / in extreme cold weather? [back to top] [FAQ contents]

From: Clyde Soles

I've used Acuvue disposable contacts to over 8000m with minimal problems. I'm about to try the new B&L Pure Visions (2-3 times more O2 permeable)...we'll see.

From: VCopelan

Thge minimum surface oxygen tension for normal corneal function is 15mm Hg. At extreme altitude the oxygen levels fall to approximately 15mm Hg during sleep. Contact lens use will further decrease the corneal surface oxygen tension. Therefore, contact lenses may not be tolerated well at very high altitudes. However, some of the newer soft contact lenses are much more oxygen permeable and should work well at altitudes above 7,000 meters. B&L PureVision is said to work very well. I would suggest trying that lens or another similiar lens.

From: Glenn

My thoughts- the cornea receives oxygen by diffusion, so even gas permeable lenses are a significant barrier, and you are talking about doing this at significant altitude. Also, I would worry that the chance of corneal infection is higher , and properly cleaning lenses would be a chore at altitude.An infection, if it did occur, could rage quickly without aggressive treatment. Finally, wind , cold, etc- worries about losing a lens. I wear contacts and love them over glasses, but find glasses a more workable solution to my vision problems.

From: Christian

Is it OK to wear contact lenses (1 week disposable type)in extreme cold conditions (-20 and below), or do they cloud/freeze or anything else unpleasant? Would it tbe better to wear to wear glasses, or do they have disadvantages

They work fine for me at those temps, and I use the reg old out every night type. The key is keeping a very small bottle of solution near your body so it doesn't freeze, likewise with the lens case, although I have had to defrost my lenses in their case many times. No harmful effects as far as I can tell.

From: Arakis

I wear daily soft lenses,and no problems in cold weather.Wind and bright sun does dry them so it's sunglasses and comfort drops.It's the cleaning and storage in sub-zero temps in the outdoors that is the problem,not when they're in the eyes.On camping trips and extended periods outdoors, I find my prescription glasses,clear,photogray,and tinted,easier to use.

From: Rob Williams

I use both glasses and contacts at different times. On denali I pretty much stuck with contacts and only wore glasses when my eyes were really dry or I need to soak my contacts. I just kept my contact lens case in my jacket pocket to keep it from freezing and in my bag at night along with the solution. Glasses were kind of a pain in the ass 'cause sometimes my breath would fog them up and then it was a pain to keep them clear.

I can say that sticking those tiny slivers of ice in my eyes in the morning really sucked. Warm your hands up real good beforehand!

From: VCopelan

Both glasses and soft contact lenses present problems in extreme cold conditions. Contacts work fine but you do have to protect hydrophillic soft ones from freezing when you take them out. The freezing should not damage them but you can't use them that way! The main problem with contacts is cleaning them in the mountains. It's not fun when the temperatures are -25 degrees or below. Extended wear contacts are an option but at extremely high altitudes most people can't tolerate contacts because of the low oxygen conditions. Soft contacts are also not great in the low humidity/high wind environment often found in the mountains. The contacts can dry out and become uncomfortable. Glasses are more trouble free but fogging can be a problem too. Glasses would probably be my first choice. Fewer hassles and you won't misplace them in your tent.

From: Kai Larson

On a very cold trip to Mount Washington in New Hampshire where my thermometer had bottomed out at minus 35f (pretty sure it was substantially colder than that, but that's as far as my thermometer would go) I had problems with my glasses. The lenses, which were made of standard CR 39 optical plastic, shrunk and fell out of their frames. I was skiing along, and one lens fell out, I bent down to see where it went, and the other one fell out. Both lenses lost in the snow in the dark, and I (being very blind without my glasses) had a pretty difficult time finding them.

I eventually found the lenses, but they didn't fit in my frames after that, so I had to affix them to the frames with strips of duct tape. I had warmed the lenses up next to my body, and in doing so, they seemed to warp a bit, altering the prescription enough that looking through the warped lenses screwed with my depth perception and gave me headaches.

My glacier glasses (which had glass lenses) didn't seem to be affected by the cold.

In short, if you wear glasses, find out what effect extreme cold will have on the lens material.

See also:

Cat Crap Lens Cleaner Anti-Fog at Campmor

What exercises can I do to help prevent injuries? [back to top] [FAQ contents]

From: rg (posted on Gunks.com)

The Old Farts Mountaineering Club Shoulder Workout.

Caution: This material exceeds EPA standards for tedium levels. Reading this can lead to drowsiness---avoid operating motor vehicles or heavy machinery while reading this post.

These are preventive exercises. You can't do them while you are injured and expect to do anything but make the injury worse. Well, actually, this isn't entirely true. Doing any of the exercises that don't cause pain while injured will help keep the shoulder strong and thereby speed recovery.

1. Rotator cuff warm-up. This is well worth doing before any upper body exercise, training or climbing. I've always been too self-conscious do this in the parking lot at the cliffs at the start of a climbing day, but I should get over it---it would be a good idea. Do this to warm up, not to train. Try for a bit of a burn, but avoid the strain associated with muscle-building.

Hold a dumbell in one hand. With the hand hanging in front of the body and the elbow slightly bent, move the dumbell in a circle by raising the arm laterally out to the side, bringing the dumbell to near shoulder height, then circling around in front of you just below shoulder level and dropping back down to the hanging position as the dumbell approaches the opposite shoulder. Do twenty of these circles with the right hand, then twenty with the left hand, then twenty with the right hand circling in the opposite direction, and twenty with the left hand circling in the opposite direction.

If done in the parking lot at the cliffs, this exercise has the most effect if, on the last repetition, enough control is lost to hurl the dumbell through the windshield of the car next to yours. The self-defense motions you subsequently have to perform then constitute the remainder of your shoulder routine.

For the other exercises, use a little more weight, but don't push too hard. Ignore the conventional wisdom about weight training and do not try for momentary muscular failure. Try to get tired and have some trouble with the last reps without producing MMF. You don't want to GET a shoulder injury doing this stuff, you want to PREVENT shoulder injuries! Rest about a minute between sets.

2. Lateral raises. Dumbell in each hand, hanging at your sides. Elbows moderately bent. Raise out to the sides to near shoulder level and lower. One set of twenty reps.

3. Front raises. Dumbell in, say, right hand hanging at side, legs in lunge position, left leg forward, left hand resting on left knee. (All the stuff with the legs and left hand is to relieve stress on the lower back.) Raise the dumbell straight forward to near shoulder level and lower. One set of twenty reps, then the same on the other side.

4. Two-arm dumbell presses. Three sets of twenty reps, each set done on an adjustable bench at a different back angle. First set nearly upright, second and third sets progressively closer to horizontal. I don't do presses in the full horizontal (bench press) position, nor in the completely upright (military press) position, because both these positions seem to hurt my shoulders. These exercises are aimed at strengthening the shoulder muscles opposing the muscles used for pullups and hanging on overhangs, and the angled presses put the arms and body closest climbing positions.

5. Shoulder Horn rotator cuff exercises. Two sets of twenty with light dumbells. It is amazing how weak these muscles are when isolated! I hate to be in the position of recommending a commercial product, especially one that seems rather overpriced, but I have found the Shoulder Horn exercises to be very helpful. Check it out at < http://www.shoulderhorn.com >.

6. Finish with some shoulder stretches (such as ones in Don Anderson's book on stretching).

If time is really limited, the best exercises are the rotator cuff warmup exercises and the Shoulder Horn Exercises, followed by the dumbell presses. The front and side raises are the least important.

The OFMC Shoulder Workout is not truly complete without some dumbell toe drops. Allow the mind to wander while at the same time tilting a collerless adjustable dumbell until the plates fall off and land on your toe. One set of one direct hit is usually adequate, although extra intensity can be obtained by allowing the sudden imbalance created by losing weights from one side of the dumbell to tilt the dumbell rapidly in the opposite direction, dumping the weights off the other side too. Skillful practitioners have been able to crush all ten toes, preferably those of their training partners. Beginners who miss completely are encouraged to remember that they still have an unused dumbell in the other hand.

From: John Byrnes

I have found, empirically, that training your two-finger "teams" can have surprising results.

For example, my right index-middle ("first") team was stronger than the middle-ring ("second") team on the same hand. However, the opposite was/is true on my left hand, and the third-team (ring-pinkie) was worthless on both hands.

With consistant training, I have made both first and second teams on both hands about the same strength, and I can now do multiple moves on a 45 degree wall with just my third teams.

So reeling this discussion back in, it's my conclusion that, yes, the ring finger is most commonly injured but that it's due to lack of focused training for that finger, and not any inherent predisposition to injury. To prevent injuries, and to rehab healed ones, design a program to strengthen all your fingers to the same level (sounds like antagonistic training doesn't it?). Refer to Horst's books for possible tactics.

From: Ken Cline

Eric Horst showed me a great, yet moderate, eccentric exercise for finger flexors: Curl a finger and then force it open (straight) by pushing with the palm of the opposite hand. Good for warmups, rehab, etc.

From: Peter Zurla

Note: this post refers to the exercises found at Ken Cline's site, noted below.

I sent this note to Ken Cline a while back. You might want to check it out before proceeding with these exercises.

As I said in my reply the basic exercises are good its just that in so many illustrations of movements they really don't explain how to position your body and the dynamics involved.

Example:

Shoulder flexion..If you look at the illustration the palm of the hand is facing in and the elbow is locked. Do the exercise with the palm facing down and the elbow slightly bent with the arm relaxed the focus should be totally in the shoulder whereas if the arm is stiff the focus will be in the arm and shoulder also when the wrist is turned you will be putting more stress on the wrist joint as opposed to the palm facing down where it will be easier to stabilize the wrist. Shoulder Abduction..Elbows locked again.

Shrugs..Elbows are bent and if you look at the illustration the movement is back and up. The tendency will be to lift with the arms not the traps. The arms should hand straight down and the movement should be straight up, not back, keeping the chest out, most people also have a tendency to round their upper back by keeping the chest out this helps with body position.

The MAIN point that should be made is that with most of these exercises the lower back MUST be stabilized. This is done with the abdominals. Remember the abdominals are the front of your back. Abdominal work must be stressed at all times. There are to many people walking around with bad backs because of this not being explained when undertaking a free weight program. If you notice there is NO mention of this throughout the entire program.

Military Press..NO mention of stabilizing the lower back. The illustration shows the weight going out and up also the palm should be facing forward not in. The illustration is totally wrong in terms of body position and arm position, where the arm, elbow should be in relation to the shoulder etc. etc.

Look at the position for Horizontal Abduction and tell me that his lower back is not rounded. You follow the instructions and I bet your lower back is rounded which is going to put a strain on that area especially when a weight is involved no matter how much it weights.

Another point..How much weight should be used, there is NO explanation at all. When you leave most people to there own devices in choosing a weight, 99% of the time it will be wrong. No pain No gain is the biggest fallacy. The main reason for going on a weight training program is to get stronger not to get injured. The benefits to weight training are endless if done the right way. You are trying to improve the QUALITY of your life...

See also:

Some Exercises for Climbing by Ken Cline

What training program should I use to get stronger? [back to top] [FAQ contents]

From: Mad Dog

1) Think volume, with plenty of warm-up milage and cool down. As in: climb more, but don't over-do the hard stuff. This means more time commitment.

2) Put up your own routes on an indoor wall. Work open hand moves from easy to beyond your limit. This will reduce your injury rate, one of the limiting factors in training on plastic. Learn how to set routes. Learn how to set moves that you do like and those you don't. Work power, endurance and power endurance. Set routes specifically to work your weakness after taking the time to be sure you know what they are. Like 1), this means more time commitment.

3) Learn to do the things that help you most and that simultaneously lowers your time commitment.

4) If you aren't enjoying yourself, ask yourself often if the effort and pain are worth the benefit.

From: Bill Folk

Performance Rock Climbing and Flash Training are a good place to start. The standard answers to your question are bouldering, dead hangs, system training, and campus boards. Bouldering will improve technique while increasing finger strength, plus it's fun. I've found dead hangs to be very effective for training pure finger strength. I have a system board, but the big benefit that I've seen from that has been an improvement in my ability to use body tension on overhanging terrain, i.e. technique, not an increase in finger strength. It probably helps to be systematic about a training program: usually I get bored training and just go climbing instead, so my results are mediocre. Hope this helps.

See also:

The Workout From Hell by John Long
Metolius Training Guides
Neil Grisham's Training Tips on DMM's site
Performance Training by Andrew Pacey
Steve Maisch's 4 not so easy steps to more power on Franklin Climbing
What training program should I use with my home gym? on Tradgirl
How do I build and use a finger board, hang board, campus board or HIT strips? on Tradgirl

How should I stretch? / Should I stretch?/ When should I stretch? [back to top] [FAQ contents]

From: Bill Folk

Actually, there is evidence that stretching before workout can increase risk of injury, while reducing maximum strength for about 30 minutes after intense stretching.

Interesting issue. can you provide some of that evidence?

Lally, D. A. (1994). Stretching and injury in distance runners. Medicine and Science in Sports and Exercise, 26(5), Supplement abstract 473. A random sample of 600 marathon entrants was analyzed. It was revealed that 35% greater injuries in the previous 12 months occurred in those who practiced stretching over those who did not. Kokkonen, J., & Nelson, A. G. (1996). Acute stretching exercises inhibit maximal strength performance. Medicine and Science in Sports and Exercise, 28(5), Supplement abstract 1130. Volunteers (M = 15; F = 17) were tested for leg strength 10 min after 20 min static, 20 min ballistic, and no stretching on separate days. Both forms of stretching decreased subsequent strength performance in each group of and the total Ss.

Regarding warming up for climbing, here's a link to an study that found a "positive association between injury rate and warm up duration";

http://www.leeds.ac.uk/sports_science/abstracts/climb99/dadoran3.htm

and a link to another which suggests that warming up doesn't protect against injury:

An Analysis of Overstrain Injuries in Rock Climbing

Before the flame war starts, I'd like to point out that I am not advocating against stretching or warming up, I'm simply reporting on some information which I found interesting.

From: Dingus Milktoast

I can't cite a single study. But exercise dudes (and dudettes), advice manuals, the Dr. Exercise Column in my local newspaper, even Paul Harvey reported on this for Christ's sake... ALL say stretch AFTER vigorous exercise, not before. Does this make a quorum? Who cares?

If you stretch on cold muscles, your chance of injury increases. Seems counter intuitive to assert otherwise. I mean, that would imply warming up is not necessary.

I stretch during and after exercise, but always after warming up sufficiently. I don't stretch before climbing. I advise others to do the same.

From: Red

What I have been saying is hat "Stretching" before a hard work out is beneficial...

Maybe. How do you define stretching? Loosening up, I agree. However, actually increasing ones range of movement, then NO that is WRONG. This is documented. Real stretching, even assuming prior intelligent heating of the body, will mess up your coordination temporarily and thus is not benefical before climbing.

See also:

Stretching — A key to avoiding athletic injuries from the Mayo Clinic
Does stretching before a workout increase the risk of injury? by Owen Anderson on Peak Performance Online
Pre-workout exercises on Peak Performance Online
The Truth About Stretching on Peak Performance Online

Help! I've been injured. What should I do? [back to top] [FAQ contents]

General Advice

From: Mike Yukish

I run through these cycles of inflammations in various body parts, and in each case the only sure cure for me has been abstinence until the pain is gone. And I mean gone. It sucks, but it works. The last case was a inflammation where a tendon inserts into the shoulder joint. No pullups for me.

Then I start back, this time remembering to warm up a ton prior to doing whatever it is I'm doing, and then not do so much of it, and stopping at any sensation of pain. Not lactic acid pain or muscel soreness, but that pain you get when your connective tissue is complaining.

Not what you want to hear, I'm afraid.

From: Ken Cline

I'm a big proponent of short term complete rest, followed by "active rest", involving light stretching and exercise well below maximum effort. Light use promotes better and quicker healing. That's my experience anyway.

From: Scott Grimes

I also think you need to look at the reason why you have inflammation to begin with. By ignoring you opposing muscle groups in your forearms you invite potential injury. Think of it as the over developed muscles, while under exertion, require to much of your tendons becasue there is no balance on the other side, weaker muscle groups. Cross training should help in achieving this desired balance.

Rest days/weeks/months, depending on the severity of the injury are important and as Ken stated light exercise will help decrease your recovery time. By exercising the injured muscle groups, lightly, you increase circulation to this area which helps with the healing process. It may be a good practice to ice down for a couple of minutes after this light rehabilitation exercise.

From: David Harris

Finding a doctor that understands the problem can be virtually impossible. My own doc is a good example. He's a good guy, was a world-class athlete in his youth, and has stayed with hard sports all his life. You'd think he'd be the perfect doc for someone like you or me, but he's anything but. It's actually reached the stage of being a joke between us. Every time I go to him with an injury, he pounces on it, "I know what it is this time, for Sure. It's a classic case of ______." Then he pauses, and says "but I'll send you over to see Doug, just to be sure."

The Doug in question is the head of the Sports Med department at the local university, and he has never yet agreed with my doc's diagnosis. For what it's worth though, he's always been able to solve whatever problem I've come to him with.

Likewise, my then wife got her legs twisted in an avalanche in 1979, and within a few weeks was in constant pain and couldn't walk. She got opinions from her doc, from two physiotherapists, and eventually from two orthopedic surgeons. Both the surgeons said the damage was permanent, that the best course was surgery, and that although she'd be able to walk reasonably well in the future, her climbing days were over. A desperation trip to the sports med clinic brought a different diagnosis, and a different treatment and prognosis -- "Do these exercises, and eventually you'll get better." Within a year she was climbing and biking as hard as ever.

Bottom line is that although there is probably a doctor somewhere that will correctly diagnose and treat your problem, there is no way for you to tell when you've found her/him. My own experience, and that of most of my friends, is that the best insight is usually to be found in a sports med doc who works with a lot of athletes. But you know the rule about medical advice (my own included) on newsgroups...

Fingers

From: Kaminski

Am not familiar with your specific injury but have had finger injuries if my own. Things to do:

- Definitely do not climb on it (know that this will be hard). The more you climb on it, the longer it will take to heal! Do other things such as biking/running to stay in shape.

- Vitamins that may help: antioxidants such as C & E may help to reduce some swelling, a good B-complex to help with the healing, Glucosamine Chondroitin (Solgar brand) is expensive but has helped me recover more quickly from soft tissue injuries.

- Check with the Dr. first for this - in my case I was told to do some light resistance exercises with my finger a couple of times a day after about a week of rest.

- When you get back to climbing, if you don't already tape your fingers, you may want to start. Since I've started taping (been about 4 years) I have not had a finger injury.

From: Russ Dubiel

I was bouldering in the gym yesterday and while crimping down with my left hand I heard a "pop" (sounded like cracking a knuckle) come from my left ring finger.

I've injured both ring fingers and both middle fingers in this manner over the years. It's usually the attachment point to the pulley, not the tendon itself. I used Ibuprofen, 600 to 800 mg a time, 3 to 4 times a day. My doctor friend said that 200 mg just wouldn't cut it, as I noticed no improvment with the standard 200 mg dose. I iced it, repeatedly. Put my finger on an ice cube and pressed down til the ice cube was completely melted. To climb, I taped the finger, x-style (see the books for photos) and then buddy-taped the ring and middle finger together, like a basketball player would for a sprained finger. I could climb a week later (your mileage may vary depending on pain threshold, and the severtity of the tear), but the pain commonly lasted for a month to six weeks. Four months for one of them.

From: Sean Parker

I was bouldering in the gym yesterday and while crimping down with my left hand I heard a "pop" (sounded like cracking a knuckle) come from my left ring finger.

I did the same thing to my right ring finger and I waited about 4 weeks and then started to climb again. It felt OK and after one hard crank I reinjured it. I then waited about 6 weeks and started to climb with it taped. It started to feel so good that I took off the tape and in one day I blew the tendon again. At this point in complete frustration I took 3-4 months off and have been climbing on it for about 3 months now. It is OK now and I have done plenty of bouldering on it. Every now and then I can feel it get a little sore and I back off and stop climbing. I haven't resorted to tape yet because I want to build back up the strength slowly.

From: Diego d'Aulignac

The worst case scenario is pulley rupture. Check if there is any bowstringing of the tendon when you bend your finger. If this is the case go and see a doctor immediately. This can be repaired by operation. Otherwise (most likely) you probably have a partial tearing of the pulley. In this case ice your finger to reduce inflammation and rest for at least a week. I've started climbing after that, but using only BIG holds. Stay off crimps, but this seems to be rather natural after hurting your finger. I tape the finger as well, but I'm not sure how much this helps. I don't take any anti-inflammatory drugs (eg Iboprofen) since I don't feel any effect. In conclusion listen to your body. If it hurts, don't do it. Thus it seems like a good idea to climb on a top-rope for a while; this way you can let go as soon as you feel the slightest pain.

From: Lindell

I had pulley rupture about 3 years ago. I tried climbing just easy stuff for a week or two, BIG mistake. Ended up with cortisone injections and not being able to grip with my right hand (finger in a splint to keep me from using it) at all for about about 8 months. After that I eased back into using it really slowly. All in all it took me a little over a year and a half before I was climbing anything that wasn't low angle with rounded buckets. It seems okay now (I still have a little bump). Now I always do the pulley tape thing with my fingers for climbing. In my case if I had had it splinted right away I might have gotten by with not using it for 3 months and climbing fun stuff in about 6 months.

I think my docs orders were to do nothing that hurt even in the slightest (even grabbing a pencil hurt me) . I had the splint to prevent me from grabbing things I could do range of motion exercises using my other hand to move my finger.

Talk to your Doctor and do what he says it is a major deal not being able to use a hand for a long period of time. I don't mean to sound preachey but it seemed when I accidently did something that just hurt a tiney bit at the time it would bother me for two weeks. It seemed that I extend the time it took me to recover by 4 months by grabbing for things accidently or doing the it's just a glass of milk that can't be that bad trick.

PS the steriod injections were a major help otherwise I wouldn't have been able to do the range of motion exersize with my other hand, what a relief being able to move your finger even if only with the other hand.

From: DB Fraz

If you avulsed the tendon in your finger from the joint then recovery time will depend on the severity of the injury and whether it is partial or complete. Lay off completely. We know you won't and in a year you'll be kayaking with all of the other injured climbers who didn't take any time off, but we (the former injured climbers of america who didn't take time off and prolonged their injuries) are obligated to say these things. Lay off totally, when it feels completely better, no pain anywhere, take 2 more weeks off. Then start back on a slab with jugs for two weeks, then vertical with jugs 2 more weeks, then slightly overhanging jugs 1 week, the vertical medium holds 1 week, then slightly overhanging medium holds 1 week, then steep overhangs jugs 1 week, then gradually start testing things and if at anytime it begins to hurt again STOP.

From: Madison

I came home to find that my middle finger on my right hand experienced pain when I tried to straighten it.

I'm not a doctor, and I genuinely believe that you should see one, and not consider my comments anything more than idle conversation.

I once had what appears to be the same condition, or something similar. It turned out to be "trigger finger," or stenosing tenosynavitis (however that might be spelled). It's a condition where some tendons become badly swollen, and the finger's tendon has trouble passing through a "loop" tendon through which it normally passes unobstructed.

To straighten the finger, I would have to yank on it, "popping" it into position, painfully. The pain, I was told, was from the swollen tendon trying to move through the normal one, despite being too big to do so.

Don't let it go unattended. See a doctor. If that's what it is, they treat it pretty routinely. However, once again, I'm just making some idle conversation; not being a doctor, I wouldn't want to hazard a guess at what you're experiencing.

From: John Byrnes

I've had this tingling in all my finger tips, less in the little finger and thumb. I was told it could be something to do with inflammed tendons or something. Know what this is all about?

Classic symptoms of Carpal Tunnel Syndrome. Visit your local doctor. It could be from climbing, more likely from typing.

From: James Sneeringer

About 1 week ago, I stupidly hit a wall as hard as I could; Problems: : 1st few days: Hurt fairly bad, trying to grip with any finger brings : pain in pinky-side of hand.

Your symptoms sound a _lot_ like mine after I hit my brother square in the head during a fight about 8 years ago (ah the hot bloodedness of youth). Luckily for me my bro broke his heel in a skateboarding fall a few days later, so I just got my hand x-rayed when we went to the orthopedist for him. It is called a "boxer's break" for obvious reasons, and often requires proper setting. This type of break (I was told) is often misaligned, and if the bones are not set correctly, you will face certain problems with using that digit for the rest of your life. It is definitely a good idea to get it x-rayed as soon as possible, and set and casted if it needs it.

From: Chris Weaver

Last night it seems I got my left index finger confused with a green onion. I tried to slice, dice and julienne it for dinner. I managed tohack off 1/8" or so from the corner of the tip closest to my thumb before pain and huge gouts of blood stopped me.

I had almost the exact same thing happen to me once while working with an Xacto knife. Sliced off about 1/8 inch off the corner of a forefinger. It bled profusely, I bandaged it massively, and eventually, after about 2 months, it healed all up. Now as I look at my finger, there is only a tiny scar along one side of where I sliced and diced. It will take a couple of months to heal completely, but unless you did something much worse than I, it should be fine to climb on after that.

P.S. Touching that area of your finger, with no nerves or epidermis present, is a really wierd feeling.

From: Theresa Drag

It's three days since I tried a new hangboard workout... one of my fingertips is still numb! Anybody else have this problem? Will the feeling come back??

It depends on exactly what happened. If you just mashed it too many times in a row, it is similar to when your butt goes numb after a drive across country. But if you felt something move or pull.... Well, I've had a finger go numb under similar circumstances and I got full feeling back after about 6 or 7 weeks. Just be careful in the meantime as you are less able to recognize additional damage that you may do to it.

From: Dan Goodman

cracked two ribs, deflated a lung, and dislocated 2 fingers. i'm doing strength exercises(squishy-ball thingie) but they don't seem to be affecting the range of motion of the fingers - left pinky and ring still are inflexible somewhat.

Got a dislocation in my right pinky last year. Reset it myself, but had some problems. Went to an ER two days after it happened, then to a specialist a couple of days after that.

He said that repeated stretching would eventually restore most of the range of motion, but that I would have a raised knuckle for life ( a "boutonniere", he said it was called) unless I had it specially splinted for several weeks. He said if I did not, in my case there would be no long range loss of function or motion, just the raised knuckle.

However, your situation might be different. Go see a good orthopedist with good knowledge of hand injuries. You might need special PT and/or splinting or casting to recover. Don't play around with it until it gets too late to do corrective non-surgical treatment.

From: Chris Maytag

Well, I'll let the finger experts here give you the real low-down, but my personal rule is: wait until it doesn't hurt at all, then wait that long again. It's too easy to cause permanent damage.

From: Gleshna

Look for an activity to do while waiting for the healing to happen. Something that does not require much finger strength, of course. Some ideas include: nautilus machines, hiking, feet only climbing, run, bike, etc.

You may need to find an alternate activity on more than one occasion over your years.

See also:

Finger Joint Injuries in Active Patients
Hand World: Information for Patients
Hand Injuries in Rock Climbing: Reaching the Right Treatment
Overuse Injuries in the Elite Rockclimber

Related threads:

No fingers - no fun
Tendons...a little poll....
How long for a finger injury?
Unknown finger injury
Finger Injury , won't straighten after climbing
tingling fingertips
finger tendon injury??
finger tendons
Finger pain
Return of the Tweaked Tendon

Elbows

From: Steve Blake

I have had a series of elbow problems over the years. If the insertion point is inflamed then you have a significant overuse injury.

If you take anti inflamatories you will likely mask the problem, train/climb and make it worse. You need to break the cycle of exercise, inflamation, exercise etc etc.

Go see a physio, find out about massage and frictions. They may help as will stretching. Sadly Rest is the best cure.

I have had the works. Physio, tablets, Homeopathy, acupuncture, Cortisone injections. All led finally to some pretty serious surgery!

From: Chris Ferro

Icing it down for 20 minutes right before going to bed for a week or 2 helps, also. But taking a month or 2 off of climbing is the only real hope.

From: Brent Ware

I've had a fair bit of experience with both medial and lateral epicondylitis (climber's and tennis elbow, resp.). What I've done to cure/keep it at a distance:

First, though there's a lot of truth to the old joke "Don't do that then", just not climbing won't in general cure the problem. Even if it does, it'll (probably) just come back when you start again eight weeks later - it takes a long time for tendons to heal. But you can refrain from doing the things that injure it. If it hurts, stop, right then. Fall on the rope if you are sport climbing (which is where most of mine comes from). Stay away from movements you know will aggravate it. In my case, this includes steering and turning knobs with my left hand, among other things, some climbing and some not. Since tendons don't seem to have the sensitive nerve endings that warn you loudly when you are damaging them (unless you completely rip them off the attachment point, which I understand will let you know immediately as you feel the tendon curl up like a windowshade in your arm), learn to recognize the pain when you are cranking hard moves and listen to it.

Water. You must stay hydrated. My elbows generally get screwed any time I let myself get dehydrated then use them hard. Water is the lubricant for your tendons; don't let yourself ever get a quart low.

Warm up. You must warm up religiously. No exceptions. You can never climb or lift weights without warming up first. Get used to it - as you get older, this seems to be one of the prices you pay for staying injury free. Warming up doesn't guarantee that you won't get injured, but for me, I've found out the hard way that not warming up will directly lead to overuse injuries. Pretty much a 1:1 correlation. YMMV. If you're old and this isn't true, then good for you, and if you're young, someday you'll remember I told you this, you little whippersnappers... eh, what's that, Nurse? Oh, yeah.

Massage and stretching. Both deep tissue and light fast warm up rubs, often and religiously. One of the US climbing rags had a pretty decent article on this recently.

Exercise the eccentric muscles - reverse forearm curls - see the mag article above.

RIC. I don't know that Elevation helps, but rest, ice, and compression do. Speaking of compression, it may be a placebo effect, but the little tennis bands seem to help me sometimes (there's a mechanical theory behind them). Ice and Vitamin I(buprofen) certainly do. Keep your elbows warm when you're using them. Wear a jacket, and put it on as soon as you are done moving, before the heat escapes.

I'm not a (medical) Dr. but I play one on Usenet. Dr. Sue will feed me penalty slack if she disagrees with me.

From: Sue Hopkins

I would only add..go climb slabs outside,it will keep you climbing without tweaking your elbow so much, and improve your footwork.

From: Frank Stock

I used to get tendon problems really bad in the elbows and shoulders bad when I bouldered a lot indoors during the winter. It seemed to be a combination of crimping, weird body tension creating stress and throwing for holds. Now I make it a point to do a lot more routes than boulder problems and stick to steep, juggy stuff rather than crimpers. If I do a thin route, it is only after doing a lot of jug hauls first. The elbow pain has stayed away, and the shoulders don't hurt much either. I also stepped back from 4 days a week to 2 or 3 during the winter which seems to help also.

See also:

Lateral Epicondylitis (Climber's Elbow) on Camp4

See also:

Overuse Tendinosis, Not Tendinitis by Karim M. Khan, MD, PhD; Jill L. Cook, B App Sci, PT; Jack E. Taunton, MD; Fiona Bonar, MBBS, BAO

How can I recover from my injury faster? [back to top] [FAQ contents]

From: Robert Fonda

I have never understood why people try to "speed my recovery". This stuff takes time, especialy as you get older. Speeding the process can only make things worse.

From: Red

I believe that the following DOES speed recovery:

- When I feel a tweak, I stop and don't test it. That's it I'm done.

- I RICE it immediately and complete rest for 48 hours.

- Then I start very, very light rehab along with massage and heat.

I believe that this does speed my recovery.

I slowly build the reps with light weight. I start with the classic 3 sets of 15 reps twice per day and then start to gradually move to power. In the meantime I use the stuff on my body that works.

We all have our beliefs.

From: Hardman Knott

I have had very good luck with Glucosimine Sulfate for climbing aches and pains, as well as inflammations from running. It has been suggested to start with 3000 mg. a day to build up in your system; typically it takes 4-6 weeks, after which you can take a maintainance dosage of as little as 500mg. I noticed a difference within two weeks. I understand the studies have been done with the Sulfate form of Glucosimine, as opposed to Hydrochloride. It is, however, twice as expensive.

From: John Davis

Take 2000-3000mg of Vitamin C spread out over the day every day. There was a study done that showed massive amounts of vitamin C speeds recovery of muscle and other tissue.

well if nothing else you'll have interestingly coloured urine. There's no way in hell you're going to be able to absorb 3000mg in one day!!!

From: Red

Take 2000-3000mg of Vitamin C spread out over the day every day. There was a study done that showed massive amounts of vitamin C speeds recovery of muscle and other tissue.

I do not know the amounts, plus I recall somewhere that too much vitamin C is not good.

However, the last time I checked MEDLINE for DOMS, delayed onset muscle soreness, only two things really worked: lots of absobic acid aka Vitamin C? and more gradual introduction of new exercise movements.

From: Jeffrey Mazzo

The immunology editor at Nature once told me, "there may be something better for the flu than a hot bath and a bottle of whiskey, but who cares?"

How can I keep my hands from sweating so much? [back to top] [FAQ contents]

From: Vibes

Try some liquid chalk dude. I used to have days when i'd start to get sweaty hands and feet just looking up at the crag heheh. The liquid chalk is an alcohol based chalk that drys quickly and gets into every crevice on your hand. Works great for me when ive got ' im shitting myself' syndrome.

From: Karl Baba

Try antiperspirant or Tinture of Benzoin before your chalk.

From: Chuck Spiekerman

how about...

11. getting a bigger chalkbag (and a whole buncha chalk),
12. wiping your hands on your pants,
13. climbing in the shade,
14. using your feet more!

From: Scott

I use a Drionic machine that works extremely well. I have a pair of very sweaty hands that makes climbing almost impossible sometimes. I bought them about two years ago and have been quite impressed. The only drawback is that the results are not permanent, thought in my case the sweating stopped for about 8-10 weeks. I paid $125US for it. Well worth it in my opinion.

Using the thing is sort of a pain: you have to sit with your hands in this contraption for a half hour a day untill the sweating stops. I watched TV as I was doing it to pass the time. It works by sending electricity (battery powered) through your hand via two alluminum plates. You adjust the amount by a contol knob on the side of the machine. I bit my lip and used the max setting. I would guess that the lesser the current the longer it takes to achieve the non-sweatyness. You can do it too much and get overly dry hands that start cracking. I had this happen once.

The web site for it: http://www.drionic.com

From: Anne in NYC

Well, you could be on the leading edge and get Botox injections in your palms. Botox is the stuff that folks get injected into their faces to paralyze those pesky muscles that form wrinkles. It is a purified form of botulism I believe, and is thought of as the age-phobic's best friend. Turns out it also stops sweating (for a few months) and is the rage here in NYC for all the fashion week types who want to remain stain free in their oh so chic armpits.

Of course, you will lose a significant amount of muscle strength in your hands. So if you're just concerned about making a good impression at a job interview, it may be for you (for a couple thou$). If you're an actual climber...I'm thinking bad idea.

From: Kirk Korver

Yes, You can have what is called a "sympathectomy". My wife had it and is really pleased. Her hands were really bad (sweat would drip from them in the cold). Understand that the operation is expensive (10K) and as always there are always risks with anesthesia.

She had the operation performed by Dr. Szarnicki in San Francisco. You should be able to do a search for his name, or "hyperhidrosis".

Kirk sent in the following addendum by email:

+1 year follow up: Her hands now sweat a little bit, mostly inbetween the fingers. Nothing bad, it's just that she doesn't have to lick her hands prior to starting up (a little moisture IS necessary), and even some times she needs a touch of chalk. She is quite pleased with the results. BTW, A side effect of the operation is that her Raynaud's Syndrome is much better in her hands. She had the choice at the time of the operation to extend the sympathectomy to encompass both the hands and the feet, but she declined.

Also note that the operation was covered by medical insurance.

From: Kreighton Bieger (via email)

I was checking out your update to the FAQ about sweaty hands.

I meant to email you before, but something that is missing is any information on Drysol. That drionic machine is bullshit, the sympathectomy is not cheap, but Drysol is readily available at any pharmacy with a prescription. You apply it at night and over time (mileage varies) it deposits keratin 'plugs' into the skin to stop sweating. I've used it off and on for years. Sometimes every day, and often I can go months without using it at all. Fortunately there aren't any real alternative uses so I can usually stock up. Anyone who has legitimately sweaty hands will find it a godsend.

From: Matt Hall

A while ago I tried using Mega Grip...

It's a mixture of alcohol, anti-perspirant and pine resin. It's fantastic. Lots of friction, no sweat and nice clean holds. It also smells nice (from the resin).

From: Jeffrey

I recall reading somewhere that tree resin was popular in Europe some time back. However, the article said that it tends to accumulate on the rock and eventually hardens and becomes slick. None of this is first hand knowledge, just a faint recollection of something I read.

From: Brent Ware

Well, the Hueco guidebook by John Sherman, back when it still mattered, said specifically not to use resin or 'pof'. Never. In no uncertain terms, for just the reasons you mention above. I fear that if you now showed up at the Happies or Buttermilks with resin, the locals might run you out of town on a rail.

Health and Training: Page 1 2

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