UKC

Hi,

I’ve been developing Climbers elbow over the last month, I reduced climbing intensity and stopped training but it’s staying at a consistent dull pain, so I’m going to stop climbing for a bit to rest it, maybe a month/6 weeks. This winter I’ve been climbing the best I ever have, climbing my first 8a’s and I don’t want to lose all of that gain and go back too far from this rest. Anyone got any ideas of good things to train while resting my injury? I’m thinking lots of core training and hip mobility but just wanted to see what others experiences were? It’s in my left elbow so still train the right a little? (My left side is definitely stronger atm) thanks in advance, Tim

In reply to timmyhobby:

It would be worth talking to a physio if you haven't already. Andy McVittie and James Walker are both worth a try, Paul Houghoughi is also very highly rated but can be hard to find availability.

My (limited) understanding is that total rest isn't necessarily great for elbows. It helps alleviate symptoms in the short term but doesn't address the underlying issues which means recurrence is likely.

Andy McVittie has written a couple of articles on UKC which are good reading:

1. https://www.ukclimbing.com/articles/injuries/treating_elbow_tendinopathies_...
2. https://www.ukclimbing.com/articles/injuries/elbow_tendinopathy_-_the_boome...

In reply to timmyhobby:

I've also had a dodgy elbow the last 6 months or so; complete rest is generally not recommended. If it's in an acute inflammation stage then a good idea, but otherwise gradual increase of loading to strengthen the tendon. I've also found a bit of massage of the forearm (not the sore point on the elbow), and squeezing a stress ball to develop a bit of a pump to be pretty helpful.

I saw Simon at Rise a few times and found it useful, would recommend.

In reply to timmyhobby:

Hi Tim

As others have said, rest is not the answer. 

Check out this excellent Lattice interview with Stian Christophersen and James Walker.   youtube.com/watch?v=aUIfegWq31E&. I was plagued with golfer's elbow for 18 months until I followed this.

Here are my notes from it (will make more sense when you watch the video)

Two reasons tendons hurt: overload or compression

eccentric/concentric/isometric doesn’t matter: what matters is enough load to generate a response: progressive loading is key

Dping eccentrics: don’t need to lift weights back up with other hand after loading [despite all the guidance out there saying you should] 

Full range of movement may be more irritating than isometrics (esp long duration - 30 secs)

Start with isometrics if pain is particularly bad and if person needs reassurance: otherwise go straight to concentric and eccentric.

Icing ok for pain relief and so can help with other things (comfort to do the rehab, sleep better)

Stretching: risk of compression of tendon, so can be irritating. Ironically, people like it because it feels like it is doing something: gets to their pain. Right thing is not the same as the thing that feels like it is doing something, so have to believe in process.

Stretching won’t address inability to cope with load

End of range of pullups compress tendon: so avoid the full lock off. 

When you don’t have full range of shoulder motion (common to many climbers), you don’t fully use lats etc and put more load on elbow.

In reply to timmyhobby:

I’ve had golfers/climbers elbow a number of times and have a Theraband twist bar which always sorts it for me relatively quickly. There are instructions for specific exercises with it on their (and other) sites.

I don’t know if this is just me, but I also find that low level hang board sessions also help. I can also correlate climbers elbow for me with periods when I haven’t been doing regular hang board sessions.

In reply to timmyhobby:

You should get it looked at, as per Remus post. 'Climbers elbow' is not really a thing, there are several different elbow problems that can occur from climbing and need different treatment. Golfers and Tennis elbow are recognized conditions and Golfers is pretty common from climbing, but they aren't the only problems you can have.

As above complete rest is probably not the answer although I have had elbow problems in the recent past that forced me to stop climbing for a couple of months because of the severity of them. They needed consistent rehab of the right type to get fixed.

In reply to timmyhobby:

You should get it looked at, as per Remus post. 'Climbers elbow' is not really a thing, there are several different elbow problems that can occur from climbing and need different treatment. Golfers and Tennis elbow are recognized conditions and Golfers is pretty common from climbing, but they aren't the only problems you can have.

As above complete rest is probably not the answer although I have had elbow problems in the recent past that forced me to stop climbing for a couple of months because of the severity of them. They needed consistent rehab of the right type to get fixed. (This was not either of the above and the rehab was different).

If you really can't afford a physio, do some more research and try to self diagnose exactly what condition you have, if possible. Rehab exercises for golfers are pretty well known by now I think, they have been discussed amongst climbers for at least 20 years so there is plenty of material out there if you are sure that's your problem.

In reply to timmyhobby:

Assuming you mean Golfer’s Elbow?  Have you tried this? https://tomrandallclimbing.wordpress.com/2012/11/23/golfers-elbow-a-possibl...
 

Doesn’t work for everyone but every time I get a touch of this I do this every night before bed for a couple of weeks and I’m cured.

In reply to timmyhobby:

The excercise that worked for me really quickly is the eccentric stretch using a hammer

but what was really key was eliminating the cause, which in my case was poor form during hang boarding (elbows locked out).

Ditto: focus on areas other than the elbow. Had grim golfers for 2 miserable years. Working on the elbow just made things worse. Eventually (on advice from an excellent American physio) turned attention to area immediately uphill from the wrist… ie massage/looking for sore points. Golfers gone in under two weeks. Theory was that tightness at the wrist end of the muscle was keeping the muscle too ‘tight’ so preventing the tendon insertion at the elbow end from ever getting a proper rest. In my case, this alternative focus worked quickly (and still keep things at bay)

In reply to Iamgregp:

Be careful with this stretch! My elbows were made a lot worse doing this. It might depend on the severity of the elbow issue, but for me it really set me back. 

I agree with most of what others have suggested, especially the part about seeing a physio who understands the demands of climbing. Andrew McVittie helped sort out my tennis elbow in the last two year.

In reply to timmyhobby:

Absolutely do not take a long break! Follow a physios advice if you can afford it. But otherwise - cut back on volume and intensity on your climbing a fair way, avoid tweaky moves and especially dynos and do eccentric weighted wrist exercises. 

I had golfer elbow for a long time and tried many approaches (including acupuncture, which did not help) and saw a number of sports physios. 

After an extended period of it constantly reoccurring and being unable fo the a few years to do pull ups without it flaring up, and even an extended period of break from climbing (around 6 months, which I now know was not needed and counter productive), I now have it under control and with the exception of an unrelated recent tennis elbow flare up, due to starting compound lifting, I have not been prevented from climbing or training pretty hard well into my 40s without golfers elbow issues. 

For me the secret was using standard eccentric loading with a weight on a cut down broom handle (think lattice sell a version which I hear is pretty decent, but really just the same thing). Benefit of the home made one is it's cheaper and you can add as much weight as you want. Happy to send you photos of my set up if you want to understand it better.

Others above have detailed the protocol - but for me I started light (say 2kg), I lifted back to vertical with the other hand at the early stages and only went to both down and up unassisted at later stages. 

My main changes that REALLY made the difference was to do three sets (8reps) one with elbow at 90 degrees (i.e. standard), one at full extension i.e. straight arm supported by the arm of a chair and one at full lock. I did read this in an article, but can't remember where! 

For an extended period even after initial recovery I did these daily morning and night (takes 5 mins) especially when climbing a lot. 

In more recent years I have found I can go months without doing them, but will monitor my elbows and start again if things feel tender. 

Trust me - you can sort this! In 6 months it will be some other tweak you will be obsessing over! Probably a finger 🤕

In reply to teapot:

Agreed. Be careful with any stretch in fact.
 

In reply to teapot:

Yes but...your protocol is assuming he has Golfer's elbow. It could be something else. If he can he should see a decent physio, or if not then put some effort in to self diagnosis before starting any exercises.

In reply to timmyhobby:

I really struggled with this for a couple of years. I tried everything, exercises, physio, injections, rest, everything. Unfortunately, nothing worked.  But all is not lost if you end up like this. I had surgery and it completely cured my condition. Look up medial epicondyle release if nothing else works for you several months down the line. Also worth checking you really have a tendon problem and not an ulna nerve compression. Do you suffer from pinky and ring finger pins and needles? If you do the solution is different. In any case if your DIY approach doesn’t work you need professional advice.

In reply to timmyhobby:

I'd massively recommend speaking to Andrew McVitie (biscuit on here) about this. 

In reply to timmyhobby: others have mentioned Andrew McVittie aka Process Physio. I would recommend his book for this and a range of common climbing injuries. https://www.processphysiotherapy.co.uk/product-page/the-self-rehabbed-climb...
The best £25 I’ve spent on injuries, and I’ve spent a lot. Great explanation of the processes and management coupled with protocols for injuries. Again, as others have said, rest/stopping climbing is not the answer. The book isn’t a substitute for a proper consultation and even if totally sure what the issue is from previous occurrences the review and analysis from a good physio is hugely valuable . 
 

Chucking another physio in the mix I know Jack Watts of https://www.highpointphysiotherapy.co.uk/ does online consultations and is a hugely knowledgeable physio specialising in climbing injuries and rehab. Based in Aberdeen/Inverness but available worldwide through the wonders of the web😏.

Good luck with it.

ps. A key help to me, I believe, has been the use of stretchy bands in all the pulling rehab exercises I do. I think the ability to gradually load and release has been the key factor. You can do that without but I’m better able to regulate with the bands plus the colour coding and differing strengths allow me clear progression.

In reply to timmyhobby:

I had an issue with golfers elbow mid last year, I’m not sure where it originated from but it really gave me a bit of a fright as I’d never had an injury before so I can sympathise with you. Definitely worth seeking out a physios advice if you can afford it. But as others have said, resting won’t help the injury and will just re-flare when you start climbing again. 

Dave Mac made an excellent video on it explaining how he helped overcome it (https://youtu.be/_iMueqiCsVI?si=ADwnCcuglmtgTWAG). I started doing several exercises to work my wrist flexors in high reps with low weight and it basically cleared it up within a matter of days and whenever I feel it twinge, I repeat the exercises and it clears up again.

I also noticed it flared worse depending on the type of climbing I was doing. If I was crimping on vertical routes, it didn’t hurt me anywhere near as much as climbing steep juggy routes, probably to do with the positioning and flex of the wrist. 

In reply to timmyhobby:

You must see a climbing physio ASAP. I have dealt with and fully recovered from golfer's and tennis elbow by seeing specialist physios who understand climbing. A general physio will be a waste of money.

I have learnt that rest is the worst thing, it will not help. I remember being told that tendons enjoy being pushed during rehab and then afterwards. 

There should be a couple of really good people in Bristol. Get in touch with them today and get yourself back on the road to recovery. 

In reply to timmyhobby:

I get it when I spend too much time cranking on overhangs. 

Bicep curls are the best remediation for me, and I rarely get elbow pain when I am doing curls regularly. 

In reply to timmyhobby:

Dave Mac's book "Make or Break" is a useful resource for understanding and fixing climbing injuries (while it isn't a substitute for a proper diagnosis from a physio).

In reply to cacheson: Dave’s book is great but I find the list of common injuries and staged recovery protocols in https://www.processphysiotherapy.co.uk/the-self-rehabbed-climber easier to work with. Sadly, I’ve used it quite a lot😩 I’ve got the Climbing Bible Injury book as well and it has some good stuff too, though it is definitely not the most used. 

None of the above are a substitute for a good physio with a knowledge of climbing.