Elbow injuries (tendonitis) are arguably the most common along with finger injuries. In this article, climbing coach Robin O'Leary and physiotherapist Nina Leonfellner look at ways to treat and prevent elbow tendonitis...
There is anecdotal evidence that elbow problems often stem from shoulder instability. The article sort of hints at this in places, but if you have elbow problems I recommend reading this: http://climbingphysio.blogspot.co.uk/
I had elbow problems for years that presented exactly as golfers elbow. I did all of the rehab described in here for a long time with no effect.
I turned to a surgeon and had some scans and other diagnostics and turned out that I actually had an ulnar nerve impingement which presents with almost exactly the same symptoms.
I would recommend from my experience paying up and getting some diagnostic tests done. If I had done this at the start I would have saved myself a huge amount of time by not self diagnosing and treating the wrong thing.
I think a lot of people that are involved in climbing to whatever degree do assume when they get elbow issues that it is tendonitis like me and I wonder how many are walking around out there with other problems and treating it as tendonitis.
My only comment is that it only touches upon pain at the insertion point of the brachialis (bicep) tendon: "The elbow insertion of Biceps is also a common source of elbow pain in climbers, which is pain located in the inside, centre of the elbow"
This is exactly what I get. Anecdotally, I have noticed many climbers self-diagnose this same pain as 'golfers elbow' - when it might not be.
I think the article should have attempted to draw a clearer distinction between true "golfer's elbow" and bicep tendonitis, and perhaps provided more info on treatment on the latter.
Yep, weak shoulders and core, as well as, technique issues are often the underlying causes of elbow repetitive strain injuries. That is why I recommend a full assessment from a therapist and then often getting some technique help from a good coach.
Glad you brought this up. As this is very common. I didn't want to go into it as I wanted to keep things short and sweet, but in hind sight should have spoke about it a bit more. This is especially relevant for junior climbers, as when you injure nerves they take a long time to heal and sometimes never fully recover.
Really, if you do not respond to conservative treatment,as this article is describing, then the ulnar nerve, shoulder, neck or further investigation should be recommended. Sorry to hear it took longer than it should have to get the correct diagnosis.
Thanks for this, again, I was trying to keep things simple,but elbow problems are more complex than that and are very common in climbers, so perhaps I should write a blur on bicep pain. In my experience with climbing bicep problems, there is often a shoulder tightness/weakness issue. So, that should be assessed and addressed. Eccentric loading for the bicep also helps, but they are different to the ones described in the article. I may have to write that one up as well ?!
> In my experience with climbing bicep problems, there is often a shoulder tightness/weakness issue
Very interesting. There is a climbing physio who works at my local wall, so maybe I'll ask him to look at it. Fortunately over the years I have learned to avoid any serious flare-ups, mostly by making sure I warm up thoroughly, and by learning to avoid certain movements which I know aggravate it. Even so, if I climb for several days in a row (e.g. on a trip) then it will likely give me problems.
I cannot answer your questions in detail as frankly it depends on the individual and where the impingement is along the pathway of the ulnar nerve and I should imagine many other pathological issues unique to the individual.
The impingement can be at many places along the pathway of the ulnar nerve and as a starting point one needs to work out where the impingement is. This requires scans and attention by Orthopaedic/Neurological physicians.
Once located the conservative treatment is to go through a process of "nerve gliding" and massage to try and free up the impingement and adjusting postural issues that may cause it etc. One thing that can cause this is seeping with your elbows bent at night. People splint there arms at night to take pressure off the nerve.
If you don't respond to such conservative approaches then the typical course of action I am told is to have surgery to free/take pressure off the nerve. On the minor scale means a debridement of the tissue around the impinged area to free it up; the extreme end of the scale can be a transposition of the nerve (they make an incision across the elbow and move the ulnar nerve from under the medial epicondile to over the other side which is supposed to ease the tension on the nerve).
I only discovered my impingement this year after quite some years thinking I had medial epicondilitis and religiously doing the exercises that Nina has described. I got fed up of getting no results from the rehab techniques described in the article and booked into see a top tendon surgeon who scanned my elbow tendons and said they were in perfect condition and diagnosed a nerve problem instead and put me toward further diagnostics.
Just thought I would share my experience with others as a caution to be careful about assuming they have a particular problem because the symptoms fit and starting a treatment programme without having a firm diagnosis. What I have discovered is that symptoms definitely do not necessarily correlate with pathology.
I should think anyone who has the symptoms of elbow tendonitis should start the regime described and give it a go but not do what I did and keep going at it for a long time when the results aren't coming through. I should have deepened the diagnostic approach much earlier.
In reply to UKC Articles: Hi Nina and Robin, thanks very much for taking the time to write this article.
I have suffered from chronic tennis elbow in both elbows for over 3 1/2 years. I have seen tons of physios ( including Nina for a different elbow problem when I lived in Bristol in 2007! )and tried every exercise under the sun but I can't seem to shift the problem.
Currently I do the hammer exercise and eccentric wrist curls every few days, but whenever I try to build up more reps/intensity the pain gets worse.
After reading your article I have started doing some core and shoulder exercises, is there anything else you can recommend?
In reply to UKC Articles: Here is my experience with elbow injuries: several years back I had tennis elbow, probably from campusing. I managed to beat it over several months with the blue (hardest) Thera Flexbar. I did a LOT of reps with this thing every day. It took probably 4-5 months but I woke up one day and the injury was gone. I also stopped climbing during this time.
Now I am dealing with golfer's elbow. This one is quite bad and was the result of both too much climbing and a single traumatic incident. I got an ultrasound diagnosis from a radiologist (a recommended step, don't self-diagnose) and I had tendinosis and a fairly large tear (clearly visible on the ultrasound). I decided to get a PRP injection and then wait for three months. This worked out not too badly as it probably got me 80% of the way there and got rid of the acute pain from the tear.
Then I started doing the eccentric exercises as outlined in the well-known Julian Saunders "Dodgy Elbows" pdf. The exercises he recommends use a dumbbell instead of the Flexbar as mentioned in the video. I agree with this strategy, as I've found using the Flexbar for golfer's elbow to be ineffective.
One change from the pdf that I've made is to take more rest. He recommends doing the exercises morning and evening with quite a bit of weight. I found this killed my elbow the next day. I do believe the weight should be heavy but I do fewer reps, just three sets of fifteen. Finally I do each rep very slowly, taking up to ten seconds to lower the weight. This is key as it seems the tendon responds to time under tension.
Regarding stretching, I find it's not effective unless it's done for a really extended period of time. I probably stretch the affected elbow for ten minutes a day or so.
Finally, there is a stretch that is not mentioned that is truly a secret weapon and has given me a lot of improvement: the Tom Randall Stretch. Google this and carefully read his post. Do it several times a day. It will take a couple of weeks but you'll notice the improvement.
It's taken eight months but I'm back to moderate climbing and I hope to be fully healed in another 4-6 weeks.
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