UKC

OK, so I've had an elbow tendon problem (medial) for SIX MONTHS. I've followed all the advice re stretching, icing, water treatment and progressive exercises and to be honest things are much better. Throughout the winter I've been able to do easy routes without problems. About a month ago I started a new regime which involved easy climbing on my wall at home using big holds. I started by climbing for 5 minutes at a time 3 days per week. All was OK. I've moved up by 5 minutes per week and am now on 15 minute sessions. Last night was my 3rd 15 minute session and today I've got background pain which is not noticeable except if if try excessive flinger flexation exercise. My question is, is it normal to have a slight background pain during the recovery phase or does this mean I have to go back a couple of steps. Experience and advice from those who have made full recoveries from this (especially from those who go back a bit) welcomed.

Thanks

David

In reply to David Bennett: Anyone…………………..

It’s a pretty common injury someone must have recovered from it.

In reply to David Bennett:

Hi David, Been through the same as you, actually had the double whammy of tennis & golf elbow! Anyway got to the same stage as you & decided to have a cortisone injection. It has cleared up the tennis elbow completely, no more niggles. Saying that though I still take a couple of Ibuprofen before what I know will be a heavy session, just to be on the safe side

In reply to David Bennett:

Oh, And I use one of the these to do specific exercises to help against tendonitis http://www.metoliusclimbing.com/gripsaver.htm

Have you been doing wrist curls with a light dumbell? That's always solved mine really quickly. lay your forearm on a table, with your wrist/hand off the edge, and lift a light dumbell with your wrist. SHould be able to do 15 or so reps quite easily. DO this every other day.

In reply to David Bennett:

Hi David,

I was off for about a year with elbow problews (golfer's elbow, pain on the inside). I had niggles for another two years, but being careful seems to have worked. Touch wood, they are all better now.

But I still have to be careful - lock-offs and pullups are dangerous, I never campus either. Listen to your body and take it slowly. Don't climb tired and make sure you warm up thoroughly before attempting anything hard.

Also, if stretching hurts. DON'T DO IT! If you are making it hurt, you are in danger of damaging something. There is conflicting research about the advantages of stretching. From my own experience, excessive stretching probably made it much worse and made the problem last longer. When I stopped stretching my elbow slowly improved.

Good luck!

In response to Bill, it's great that the injections seem to have worked for you, but from reading around the subject when I had problems, I'm not sure they are a good thing to recommend. For instance, a quick google and the first page I click on has this to say about the disadvantages of cortisone injections:

"Tendons can be weakened by corticosteroid injections in or near tendons. Tendon ruptures as a result have been reported."

In reply to David Bennett: Hey guys, thanks for the feedback. I've been following the advice here http://www.nicros.com/archive/climbers_elbow.cfm and have also been using one of those gripsaver things and doing my wrist curls / triceps stuff. I thought I'd got it beat until the other day. I guess I'm going to assume any pain = bad and slow down my rehab...............unless anyone knows otherwise.

Thanks again
David

In reply to David Bennett:
I've had a very similar experience to you, and am at a similar stage (currently still on the 5 mins on wall every other day). All I can say is that background pain in my elbow seems to bear no relationship to the exercise I have given it that day. Missed a day's exercise earlier in the week due to another commitment; the following day it was very stiff and sore. Yesterday I pushed the exercise quite hard; today it doesn't hurt a bit. There seems no rhyme or reason (and it's driving me mad trying to make sense of it...)

In reply to David Bennett:

I'm getting great results doing eccentric work (I think folk call these negatives) - basically I use my feet to get up into the lock off and then lower down really slowly - I am using added weight (about 20 kgs) and it seems to work like magic - so much so I nearly undid all the benefit and started working too hard again - lesson learned. Also second the reverse wrist curls.

BTW I was given to understand that the tendonitis we talk of in this respect (golfer's elbow) is really a repetitive strain injury - no suprises there - and has been shown to be non inflammatory and should be correctly termed tendonosis - so anti-inflammatory treatment (steroids, NSAIDS) shouldn't really help and really should be avoided, unless of course you have an acute tendonitis caused by trauma (a sudden load). I'm not qualified to be definitive about this.

The notion of total rest from climbing is quite unacceptable to me - whilst I can still work through this I fully intend to - maybe we should start a tendonosis blog...

In reply to Diogenes:

I'd never heard this before. Do you have any more information or a reference I could look up? Presumably, if true, cortisone injections would be useless too.

In reply to heleno:

Aye, If cortisone injections are useless someone needs to tell my right elbow which is now (touch wood) working hunky dorey

In reply to heleno:

http://www.tendinosis.org/

In reply to Bill Davidson:

I don't think anyone is saying that cortisone is useless. If it was, it wouldn't be used at all. What they are saying is that not everyone will benefit and that there are significant risks attached. People need to make their own minds up whether their condition is sufficiently chronic and intractable to make those risks worthwhile.

Thanks to the links from this thread, lateral tendinosis would appear to be my problem, and while the discomfort I get from everyday activities like lifting coffee cups and shaking a can of shaving foam seem to have lessened, I still have a dull ache with occasional twinges even after four months. I decided to head up to Crookrise yesterday on the premise that even the walk up there would be useful in helping me shed some of the flab I've accumulated while not climbing. I soloed a couple of easy VDiffs and the elbow is a bit achey this morning, so it's back to cold water treatment for the next couple of weeks.

What exactly are reverse curls - is that laying your arm over the end of the table, and moving upwards from the wrist with your knuckles pointing up?

In reply to hutchm:

Just to make it clear I've had one injection & it was only after doing what you're doing at the moment that I went for it. It just wasn't clearing up. The guy who gave me it is a Doctor & a qualified Physio & had no hesitation in doing it, in my case it certainly worked & therefore I would recommend it to anyone else. He did say that accuracy was necessary & that in his opinion the ones that didn't work had been slightly out.

In reply to hutchm:

Oops, forgot about the curls. Yes those are the ones and you can use your knees as well as a table. Barbells & dumbells provide a bit of variety but dumbells may be better as you cant over compensate with the good arm. I would try the Metolious grip saver exercises as well they're really good.

In reply to heleno:

http://www.tendonosis.com/

There's some stuff here that blows away conventional wisdom on the subject - as ever correct diagnosis is vital...

In reply to alan edmonds and Diogenes:
Thanks for both those links. I'm having a major rethink about what I should be doing with my elbow in the light of these (and some doubts about my current physio...)

In reply to heleno:
This is quite informative

http://www.physsportsmed.com/issues/2000/05_00/khan.htm

In reply to David Bennett:

I'm with Helen in the sense that I have been driven mad by my elbow. It actually seemed to hurt as much after I took six weeks off to rest it and try and beat the twinges I have had on and off for two years now. I wore a support for ages but have since learnt that these are not good to wear for prolonged periods of time as they can mask the problem. You also don't develop the tendons if you are wearing supports apparently!

I couldn't bear to stop climbing althogether. So I reduced the frequency and intensity of my climbing and take long rest periods between climbs. I stay away from the triggers (overhanging and closed hand crimps). I live with mine in a not getting worse not getting better state!

In reply to Diogenes:
Thanks - that's a useful link.

Not sure whether I feel better or worse about the tendonitis / tendonosis issue. In some ways it makes more sense of my experience over the last 6 months, but on the other hand, the talk of 'necrosis' makes me feel very gloomy indeed...

Has anybody got any positive experiences of coming through this?

In reply to heleno:

Yup - it's already getting better!... I'm not yet back at mad dog levels with strength work of course but given the stuff hereto mentioned I'm not getting worse... that's good injury management as far as I'm concerned - I haven't had to stop climbing at all - and that's what really matters...

You can work hard at getting better - are you massaging, doing eccentric work and training the antagonists? if so you are in control. The fact that you got into this problem indicates you are probably already highly motivated and strong... work on improving some other aspect of your game while you wait for your tendons to adapt...

In reply to David Bennett:

This whole topic seems like a dark art to me. My layman's suspicion is that the input factors into tendon healing are so complex - lifestyle factors (stress, sleep quality, etc), non-climbing strains (RSI at work, etc), nutrition, hydration, etc, etc - that no medical professional's advice can be expected to "work" in a straightforwardly causal way. Worse, the person I know who suffers most from tendon issues is also a very experienced and wise physiotherapist ... But FWIW, especially as we are about the same age, these are two recent experiences of mine.

Last August I experienced a nasty inner elbow tendon problem in my right arm after doing some lock-offs when unwarmed up. I then exacerbated it - I think - by doing too many dips in my company's new gym in early September. For the next two months I went from bad to 90% healed via a classic sequence of complete rest (2 weeks), reversion to climbing after promising improvement, relapse and more rest (1-2 weeks) and so on. I also bought some light dumbbells and did a lot of reverse wrist-curls. It's all lovingly documented at this site on the Fit Club #24 to #33 threads. One weird aspect of this period I noticed is that "tough-love" therapy - going out and climbing far too much all day - had absolutely no correlation with immediate after-effect and if anything seemed to accelerate recovery at a key point (perhaps in some subtle way a decent level of "abuse" is necessary to persuade the body to start rebuilding the collagen?). By mid-winter - prime season in this part of the world - I was stronger than I have ever been and redpointed a first ascent project that's unquestionably the hardest thing I have ever done.

Recently, though my climbing intensity is pretty low, I have started to get persistent aches at the inner elbow insertion point in both elbows. I'm really sure that the major aggravating factor, if not actual initial cause, is that we had a second child in February and I spend a vast amount of time carrying and moving him. It seems absurd as even now he only weighs 7Kg but the muscles get engaged for long periods at a time, often without any warm-up (ie middle of the night!). I am hoping that the two months I'll have off baby duties this summer will therefore allow some recovery. We'll see ...

Slightly off-topic but one other injury avoidance practice I have adopted that I suspect to be worthwhile is to switch my mouse arm at work every few weeks. I believes this helps avoid RSI-type problems at the shoulders and elbows, even though the actual physical loading is very slight.

In reply to David Bennett:

This seemed like a good summary of tendonosis care from some body builder type person, including describing friction massage:

http://www.professionalmuscle.com/forums/archive/index.php/t-20048.html

In reply to tobyfk:

Good post. My lateral elbow tendon problem - which I now think is more likely to be -osis rather than -itis, was showing only slight signs of improvement with the usual rest/cold water/support, and this week I decided to do some light climbing, partly to improve my mental outlook, start shedding weight simply by doing the walk-ins, and to see if the response would be positive. So I've being doing a smaller version of my usual circuit at Crookrise - sticking to easy solos and climbing up and down the steeper starts to other routes, with big holds only and halting on the appearance of any ache. There have been no real adverse effects, even when a foot slip unexpectedly had me hanging full weight on the elbow. In fact I think the stress is starting to strengthen the area. But I've yet to test it with smaller crimp holds which will isolate and test the affected tendon. I can see that this might be a very risky strategy for some - it's born out of a slight desperation on my part. I think the aerobic exercise connected with a day's climbing is really helping, perhaps more so than the moves themselves - and the non-route movements you do at the crag - lowering your weight down on your arms in descent gullies, scrambling over boulders etc, may also be really helpful.

Funnily enough, I can't actually remember the injury itself, but I suspect it happened when my five-year-old lad swung his whole weight onto my arm unexpectedly just before Christmas. So you've got that to look forward to!

I think you're right about computer use too - mine is definitely worse after a long day at work using a mouse and keyboard for 8 hours.

In reply to David Bennett:

I have checked out the above documents, but am still non the wiser whether I have tendinitus (rare, better), or tendonosis (common, worse)

Any advise

Pain on the inner elbow, at base of bicep (like a tooth ache). I have had several re-occurances over the last 5 months. Probably 4. Normally comes on after more than one day bouldering in a row, although not always. Sometimes appears when climbing not too difficult Responds well to 2-4 ibuprofen within hours of pain. Last had symtoms on Saturday, right elbow only. Had three days rest and treated with ice and heat pads. Had big bouldering session at Raven Tor today, followed by 2 hours training inside (Seems a bit intense I know, given my symptoms, but my wife had bought me a surprise 30th bday present-training day with Ste McClure, so needed to get my moneys worth!).Thankfully I have no symtoms, but will be having a rest day tomorrow.

So have I had several occurances of acute bicep tendinitus or one on going injury of tendonosis?

In reply to tobyfk: Interesting your comment about tough love. I finally just got brassed off with it and just went back to training, but still not at very high intensity. So far I have had little or no pain at all (touch wood). I've now ramped it up quite a lot am still symptom free and I'm hoping I've got this bout cured.
It got me thinking that you can delay the ramp up too long for your own good because I had felt as good as when I originally posted for a couple of months prior to that but was too frightened of a set back.

Thanks to all for your comments / advice.

David