Elbow tendonitis long-term management.

[i.munro]

I've lost the last 2 summers to tendonitis & I really  don't want to lose any more time.
I've got it under control with rest, rehab, stretching etc but I can sort of feel it lurking in there waiting to bite me again if I start to bring  either the volume or intensity back up.

Anyone else in this situation?
How  & when do you fit in eccentric rehab exercises around training?
Has anyone tried massage?
Any other suggestions?

Ta as usual

[SA Chris]

Tendonitis or tendonosis?

Apparently there is a difference. I have fought with it intermittently over my later climbing career, but have been doing the twisty arm stretch as per the article below whenever I feel it flaring up, and it seems to bring it back under control. Like any chronic injury though, you probably have a lot of scar tissue?

http://www.athlon.com.au/articles.htm

see - dodgy elbows article.

PS usual disclaimers apply - I know squat about medicine etc.

[erm, sam]

Dave Mcleod has a bit of stuff about injuries
http://www.davemacleod.com/articles/climbinginjuries.html
He has been talking a fair bit about the hot and cold water treatment being very effective and recently posted about it sorting out his lurking elbow injury.. Have a look...

[i.munro]

Like any chronic injury though, you probably have a lot of scar tissue?

I assume so, which is why I was wondering about sports massage.

[SA Chris]

You can massage it yourself fairly effectively?

Have you actually been to see a physio about it?

I know when I knackered my rotor cuff that biting the bullet and spending money for a weekly visit to the physio definitely helped with recovery.

[i.munro]

Yeah went to see a physio when it was bad.
It's fine now, no pain but it doesn't feel the same as the other one, scar tissue I suspect, as you say.
The physio advised me against massage when it was bad but I'm wondering if that's what I need now to  break up the scar tissue.

[pppat]

I  have had Bracialis/Bracioradialis tendonitis in my left elbow for the last 6 months, it wont piss off.

So Ive started a new rehab regime recently of ice massage followed by a tough massage lengthways on the affected tendon.

[Skinny Pete]

Hmm... Which thread to resurrect?

I'm also in the situation of having lurking left elbow tendonitis/tendonosis (golfers).  Got particularly bad after a three week sport trip back in Sept, where I probably should have taken it easier, but wasn't going to waste precious holiday being sensible!

Physio got it under control with cross-friction massage and an accupuncture session (don't know how much effect this had really) and it has been gradually improving with eccentric wrist curls, more massage and icing.  I've also been looking at form during climbing - I seem to naturally turn my left wrist inwards and right wrist outwards which may not be helping.  I've been experimenting with wrist angles to try and identify particular positions which cause a problem and try to adjust my climbing style accordingly.  Not really been doing this long enough to know if it's really any benefit, but it came from a comment by Dave MacCleod that problems like this tend to stem from poor movement.

I'm now at the point of starting to up the training intensity again and don't really know how best to fit the eccentric curls into the training.  I've been doing a bunch of press-ups, crunches, shoulder presses, dips etc as part of a warm up routine.   However, intuitively it doesn't feel right doing the eccentric curls and potentially stressing the tendon before climbing.  I'm thinking it may be better to do the climbing, then eccentric curls, then get some ice on it pronto to keep inflamation under control.

Any thoughts or experiences?

[chris05]

I'll be watching this thread with interest. I have tendonitis in both elbows which flares up if I climb or surf for more than one day in a row. I perhaps foolishly haven't payed for physio as I doubt most have enough specific knowledge about the stresses exerted by specific (less common) sports, although i guess the injury is common enough.

 I use the twist and go rubber thing (similar to a thera-band flex bar) as well a range of stretches, I have also been icing it and massaging with deep heat and ibuprofen gell which seem to just about manage it but dont seem to offer a long term solution. I've recently started the hot/cold treatment recommended by Dave Mac. Interestingly it doesn't seem to be aggravated by fingerboarding.

Be good to hear of others thoughts, especially THE miracle cure thats bound to be out there somewhere...or not

Also if anyone has any recommendations for physio or sports massage near Nottingham I'd be glad to hear them.

[SA Chris]

an accupuncture session (don't know how much effect this had really)

Watch out, you may have some of the more militant member of this forum turning themselves into Hellraiser in mass protest if you are not careful.

[JamesD]

Tendonitis or tendonosis?

Apparently there is a difference. I have fought with it intermittently over my later climbing career, but have been doing the twisty arm stretch as per the article below whenever I feel it flaring up, and it seems to bring it back under control. Like any chronic injury though, you probably have a lot of scar tissue?

http://www.athlon.com.au/articles.htm

see - dodgy elbows article.

PS usual disclaimers apply - I know squat about medicine etc.

As a long term sufferer of Tendonitis (nearly 10 years now), I have picked up a few things over the years, the above advice on this site, and various articles are excellent.

In addition to this, here is what I have personally tried over the years that has worked for me:

Hot/Cold Ice treatment: Excellent but needs to be done 1-2 times a day at least to see the benefit and for long periods of time, Sauna to Ice cold shower/plunge pool seems to work a treat as well.

Deep tissue massage, painful but makes a huge difference, 1-2 a month for a while and I felt pretty much perfect for ages, but it is expensive to do this for a number of months, would do it all the time if I could afford it!

Steer clear of fingerboards!
Use other devices to train your grip in various ways, I was doing 1-2 sessions a week for a couple of months indoors with no problems, 1 finger-board session the other night has put me out for a week, and it didn't even feel like I was trying that hard!

Regular self massage, avoid tricep exercises that put the joint in risky positions where there is a high chance of injury: such as overhead tricep extensions, one of the worst exercises for injuring your elbows, steer clear of these or anything similar, also avoid tricep exercises where the wrist has to twist much.

Swimming, absolutely awesome, I like to switch up between front crawl, back crawl, and breast stroke, great for recovery/strengthening of the elbow when its feeling a bit fucked, and very complimentary to my bouldering I have found

Oh then there is the shitty last resort: Hydro Cortisone injections, which can help if they get really bad, had them and they did the trick, don't think I would resort to that route again though, as it means a lot of time off recovering to get the best results.

My two pence ^

Hope that was useful 

[Skinny Pete]

Steer clear of fingerboards!
Use other devices to train your grip in various ways, I was doing 1-2 sessions a week for a couple of months indoors with no problems, 1 finger-board session the other night has put me out for a week, and it didn't even feel like I was trying that hard!

Interesting that - I've found fingerboarding the only way of training the last few months.  I found the fingerboard gave me more control over how I was loading the elbow and meant I could avoid anything that hurt too much.  Bouldering had too much chance of a foot popping and yanking the elbow unexpectedly.

Lots of useful advice around on here - I wish I had taken notice of stuff like this when I was young and stupid with elastic tendons!!

[i.munro]

Hmm... Which thread to resurrect?

lI'm now at the point of starting to up the training intensity again and don't really know how best to fit the eccentric curls into the training.

That's been my problem as well. Conclusion so far. You have to keep doing them. Same day as climbing is a baaad idea.
Interesting to hear the comments on deep-tissue massage. Now I just have to persuade the missus to find time among the paying clients to fit me in.

[michal]

Do the eccentric exercises after climbing.  Climbing/training, exercises, light massage, stretching, hard massage, ice...in that order.   Seems to be the least intrusive way to fit the exercises in and make the elbows feel better after a hard session. 

[psychomansam]

I had some form of elbow tendonitis around a year ago; I started climbing by bouldering, did so for three months, with of course some predictably bad technique, and it hit me in both elbows. I could hardly climb.

Took two months off before it recovered enought that i tried again. I still had reduced pain, despite climbing less. I was also finding problems with loading my arms in certain ways - i.e., reduced power/strength.

Eventually bit the bullet and visited "the clinic" and saw john ostrovskis.
 It took him all of a few minutes to very conclusively work out what the problem was.
My uppper back muscles (trapezoids i believe?) were knotted up and locked solid, meaning my shoulders had no support and were operating at a much reduced strength...
But what's really interesting about this is that without the proper support from the back/shoulders, my arm muscles were taking on exceptional strain, and he considered this to be the cause (at least contributive) of my elbow tendonitis.

He treated me with two sessions of extremely aggressive phsyio to my back and by giving me exercises to keep my back muscles mobile. My strength returned and i've had no time off climbing in the last year.

I believe John regularly prescribes these exercises, and i can describe them if anyone is interested. I'm sloppy with them but whenever i begin to develop any elbow problems, picking up on these pretty much sorts it out.

I avoid fingerboards altogether and consecutive days bouldering(certainly inside), but hope to be able to strength train at some point! I am getting stronger but for now i'm focussing on technique and weight loss, or at least trying!

Mmm, bagel with cream cheese.

Sam

[highrepute]

The first step in the long term management of any injury that is "long term" is seeking professional help. go see a physio. if you don't want to pay they're free on the NHS, you'll have to wait but you've probably been putting this off for months anyway.

Don't climb if there is pain
Ice bath or hot/cold just like dave mac says - 1-2 daily
the athlon article linked higher up in the thread is very good and was recommended to me by my physio.
Concentric wrist curls - 1-2 daily
weights - tricep and shoulder exercises - not sure about these but there some excellent workouts described in the "Antaganistics basics" thread

Knotted and locked back seems to be common in all my friends who've seen a physio, massage will help this. you can attempt to do it yourself with a tennis ball against a wall. find the painful bits of muscle a really work them for a good few minutes. it should hurt. but if the tightness is in your neck you'll struggle to self massage this (girlfriend?)

For keeping back loose I've heard press-ups with shrugs are good. I've never been described them but I think psychmansam might have been?

[no medical expert disclaimer]

[Skinny Pete]

That's been my problem as well. Conclusion so far. You have to keep doing them. Same day as climbing is a baaad idea.
Interesting to hear the comments on deep-tissue massage. Now I just have to persuade the missus to find time among the paying clients to fit me in.

I've also come to the conclusion that I need to do the exercises often - I think the Atlon article recommends six days per week.  Obviously to do this at some point I have to do the exercises on the same day as climbing.  Michal's sequence sounds like a good plan, though a 'hard session' is a bit beyond me at the mo...

Physio showed me how to do the friction massage at the right intensity and in the right place without hitting nerves etc - I would not want to do this without professional advice first.

[i.munro]

I've also come to the conclusion that I need to do the exercises often - I think the Atlon article recommends six days per week.  Obviously to do this at some point I have to do the exercises on the same day as climbing.  Michal's sequence sounds like a good plan, though a 'hard session' is a bit beyond me at the mo...

From " a hard session is beyond me" I take it you're still at the pain stage.
My physio advised 3 sets of eccentric wrist curls twice a day when I was at that stage with a really light weight. Clearly this is nothing to do with strengthening. In fact I suspect it's just to keep you so busy you haven't got time to climb :-)
However having paid for physio I did it & it worked. As I returned gradually to climbing she said NOT to do it on climbing days.

[Skinny Pete]

From " a hard session is beyond me" I take it you're still at the pain stage.
My physio advised 3 sets of eccentric wrist curls twice a day when I was at that stage with a really light weight. Clearly this is nothing to do with strengthening. In fact I suspect it's just to keep you so busy you haven't got time to climb :-)
However having paid for physio I did it & it worked. As I returned gradually to climbing she said NOT to do it on climbing days.

I had similar physio advice on the wrist curls and have since built the weight up a bit.  I'm just about beyond the pain stage - no pain day-to-day and this week I have managed two very careful sessions on the woody.  Each time I did about 40 minutes with no pain at all, then started to feel a tweak and stopped immediately - no post-climbing pain doing this.  Plan is to gradually build up the intensity and see what happens.

What stage are you at?  Presume from your comments that as you returned to climbing you reduced the wrist curl frequency?

As an aside, I have a hunch that guitar playing (badly!) did not help with all this - I put the guitar down as well for the last couple of months which is a bit annoying as it is a good sedate climbing substitute!!

Heading out this afternoon to St Bees so see how it copes with the real thing...

[fried]

Are all elbow tendonitis treated in the same way?

I have had what I believe to be brachialis tendonitus since I restarted climbing last year (diffuse pain that is difficult to locate the exact centre of, with accompaning nausea if I don't stop) this is entirely self-diagnosed with help from Dave Mcleod's blog. This condition seems to become worse with pushing and squeezing type movements (font is murder). The first day I climb I'll be fine, but if I don't rest for a week afterwards (for font) or 2 or 3 days (for indoors) it will invariably start within the first 5-10 mins, leaving me no choice but to stop. Strangely it's only bouldering which seems to cause this and not normal routes.

There seems to be a great variety of conflicting information about managing elbow injuries and I'm slighly confused if they are all treatable in the same way.

I really should see a physio, but would like one who had some experience with climbing injuries (and I'm based in Paris).

If anyone has any advise it would be appreciated.

[The Sausage]

As a long term sufferer of Tendonitis (nearly 10 years now)...

...I don't suppose you'll have the most effective solutions   

I have had what I believe to be brachialis tendonitus since I restarted climbing last year (diffuse pain that is difficult to locate the exact centre of, with accompaning nausea if I don't stop) this is entirely self-diagnosed with help from Dave Mcleod's blog. This condition seems to become worse with pushing and squeezing type movements (font is murder).

This almost certainly sounds more like a shoulder instability problem - have a look at some previous threads, perhaps the 'antagonstic basics' one. Put "shoulder instability" into the search and you'll get something.

[tim palmer]

At the risk of being unpopular i have to say i am slightly cynical of the usefulness of physiotherapy for tendonitis.   To add some objectivity to this opinion, this evening I had a quick look on Cochrane collaboration and medline just to see if there is any evidence of physio, steroid injections, ibuprofen type drugs or acupuncture being useful in the longterm for tennis elbow as it is a fairly common complaint. 

The answer is there is no good evidence anything is better than planting an onion at the bottom of your garden and having a bit of a rest.  Steroids are good for a few weeks but recurrences tend to be worse, physio shows some benefits initially but at 52 week follow-up there is no difference when compared to watch and wait policy, like-wise for acupuncture.  The caveat to this is of course that there are very few good studies into the efficacy of physio for this sort of thing.

http://www.cochrane.org/reviews/en/subtopics/80.html

From my own experience of tendonitis is that having a bit of a rest and avoiding things that hurt is as good as anything. 

[blacky]

I had 'golfer's elbow' for about 9 months in 2008 because I ignored it at the start and just tried to climb through it, so I would definitely recommend a little rest and then, as Tim said, avoid things that hurt. If that means doing easy circuits at the works for 6 months then so be it. One thing that helped me get over golfer's elbow was stretching as the excersises in that aussie guy's article didn't work for me.

I have also just had a touch of 'tennis elbow' recently and I have been resting and massaging with ice, and I mean really digging into it, since I first got pain. I have definitely noticed good improvement with each day, but I think that is because I caught it early, and now there is only a little pain when I press on the epicondyle bit. I assume there's no medical ambiguities surrounding the effectiveness of ice treatment for reducing swelling and helping healing?

The only times I've had physio for anything the ratio of cost to healing has been pretty unfavourable.

[Brolly]

During most of 2009 I had bad tennis elbows in both elbows.  This started in Feb '09 while doing a long day building at the Depot (using a lump hammer banging t-nuts in for 10+ hours) as I was unable to realistically rest my elbow while doing the build so I used my left arm more and that why it developed in both.  By the time we opened the Depot both elbows where in a really bad way - which was really demotivating 

Over the next 8 months I saw two different physios (probably more than 25 visits), had acupuncture, saw my GP twice, tried essential oils, lots of stretches and exercises (most mentioned above), extended rest, taking it easy, ice, heat, taping, various supplements, then I saw a soft tissue consultant who specialized in elbow injuries.  On my first consultation, he gave me cortisone injections in both elbows.  He did this via a different technique to how a GP would do it, and deliberately caused multiple punctures across the tendon, this supposedly promotes a healing response in the damaged part of the tendon.  It was agony, I passed out on the first injection!  This did seem to work for about 6 weeks, but then they reverted back (this is without climbing heavily on them).  On my follow up session he thought the next stage was an operation on one of the elbows to cut out the section of damaged tendon, this had a fairly long recovery time and was by no means guaranteed.  At a similar time Tim Stubbley showed me some simple exercises using a light Thera band and I started to do these. I did these three times a day and before any climbing session.  Within a week I felt a little bit better, then after about a month I was able to start climbing a bit harder.

I’m still not training properly ie I’ve avoided campus boards etc and I can still feel a lurking presence, but I am able to pull quite hard.

I don’t know what has actually had an impact, was it a combination of the above, has it just eventually healed over time, have my sholders stabilised because of the Theraband exercises ?  What I do know is that they seem to be a lot better and I’m so glad I didn’t take the consultants advice (in fact it may have been the fear factor of going under the knife that caused a healing response  ) .
Anyway I just thought I’d share that with any tennis elbow sufferers, it can get better!

Cheers Oliver

PS if you want to know the exercises PM me 

[fried]

I have had what I believe to be brachialis tendonitus since I restarted climbing last year (diffuse pain that is difficult to locate the exact centre of, with accompaning nausea if I don't stop) this is entirely self-diagnosed with help from Dave Mcleod's blog. This condition seems to become worse with pushing and squeezing type movements (font is murder).

This almost certainly sounds more like a shoulder instability problem - have a look at some previous threads, perhaps the 'antagonstic basics' one. Put "shoulder instability" into the search and you'll get something.
[/quote]

Thanks for your answer, which seems to highlight the difficulty in getting any kind of diagnoses on elbow injuries. I would be entirely unsurprised if the root cause is in my shoulder and not in the elbow. Although the centre of the pain seems to originate in this area if it worsens it can go from the back of the shoulder right to the wrist. It can happen in both arms although normally in the left (I'm right-handed), the pain will generally come on very quickly if I try to boulder more than once in a week, although climbing routes doesn't seem to affect it as much. The pain feels similiar to chillblanes in the centre of the muscle and can last for an hour after climbing, even carrying a bouldering mat can be agony. Any activity can bring it on again (carrying something heavy, pushing a door, swimming) it will also generally start within the first 5-10 mins of a climbing session.

I read through the 'antagonistics' thread and this all make sense, but I'm still finding it difficult to understand what a good training program would be. At the moment I'm doing reps of 30 press-ups and that's it. Do you have any advice on specific exercises?

Oh, I'm 38, have bad posture, walk like a monkey and am just back from a 10 year climbing break.

[i.munro]

physio shows some benefits initially but at 52 week follow-up there is no difference when compared to watch and wait policy

In fairness, I would expect any injury, that physio could address, to heal if I stopped aggravating it for 52 weeks!
What I hope to get from a physio is the ability to get back to climbing faster & (hopefully) a reduced chance of re-occurrence.

The other thing I note is that there seems to be a theme of shoulder instability running through the answers on this thread.
My physio diagnosed the same root cause & I've noticed that a lot of the so-called antagonist exercises that people recommend overlap to some extent with the exercises I've been given to try & address this.
For example the last few cm at the top of a press-up is the same as one of the exercises I've been given  for the serratus anterior. Is it possible that the reputation (among climbers) of the injury-proofing effect of antagonist training is this incidental strengthening of the shoulder stabilisers (when donne with the correct form)?

[tim palmer]

physio shows some benefits initially but at 52 week follow-up there is no difference when compared to watch and wait policy

In fairness, I would expect any injury, that physio could address, to heal if I stopped aggravating it for 52 weeks!
What I hope to get from a physio is the ability to get back to climbing faster & (hopefully) a reduced chance of re-occurrence.

I think you might have got the wrong end of the stick, the follow-up was at one year, not the duration of watchful waiting.  What i meant was, in the longterm physio is no better than being sensible for a similar duration.

[Stubbs]

Is it possible that the reputation (among climbers) of the injury-proofing effect of antagonist training is this incidental strengthening of the shoulder stabilisers (when donne with the correct form)?

I don't know any climbers that do 'antagonistic' exercises, but I know a lot who do theraband rotator cuff exercises.
I think the 'reputation' of any 'antagonist' exercises stems from misguided folks that think doing 50 pressups a day is going to save them from tendonitis.

[Johnny Brown]

I seem to remember Wobble telling me about going to The Forest with Team-shy-yorkshire-8b and them all doing press-ups every night to prevent font elbow. And who'd argue with them! Hopefully he'll correct me if I'm wrong.

As long as I do Yoga most weeks it seems to keep my shoulder instability under control. I've never had elbow problems up until this year, which I put down to going to font in Oct before I'd got the body back into bouldering.

[Stubbs]

It'd be interesting to know if any of the more waif-like members of the board have ever suffered from elbow issues: Paul, Sausage, Dense etc? I reckon Wobble and to a slightly lesser extent Messrs Clifford and Birch of of a body type which will be less susceptible to elbow problems in the first place.

[Johnny Brown]

Not likely after all those press-ups!

[dobbin]

It'd be interesting to know if any of the more waif-like members of the board .... Dense

hAHAHAHAHHAHAHAHHAHAH! Dense - waif like! brrrrilliant! i love you  stubbs.

[Falling Down]

I've been suffering with Tennis Elbow since August. Had 15 or so Physio sessions that got rid of a load of scar tissue and seemed to alleviate the symptoms but I keep getting the odd random day when it seems to be back again like on Saturday when I was doing some work on our fireplace when I was using a hammer and lifting stuff.  Sunday it was sore again.... 

I'm doing the stretches and keeping my back and shoulders as supple as possible and not doing much climbing indoors until I've had a good stint outside and see how it feels.

[i.munro]

I think the 'reputation' of any 'antagonist' exercises stems from misguided folks that think doing 50 pressups a day is going to save them from tendonitis.

It's certainly something I get told a lot.
My question was whether the effect on the shoulder stabilisers means that ,like a lot of myths, there's a little bit of truth buried in there.

[highrepute]

It'd be interesting to know if any of the more waif-like members of the board have ever suffered from elbow issues: Paul, Sausage, Dense etc? I reckon Wobble and to a slightly lesser extent Messrs Clifford and Birch of of a body type which will be less susceptible to elbow problems in the first place.

I think I'm about as waifer-thin as they come <9st and I've had elbow problems.

[TMR]

i had serious issues with elbow tendonitis around a year ago (pain radiating up from elbow to shoulder),, at the time i just used to concentrate on routes, but more than two days in a row bouldering would always bring it back (font and grit being the worst aggravators). i read an article and spoke to some physio friends who claimed that all the repetive pronated (palm away) actions involved in climbing lead to imbalances. while sitting out a month with a tweaked finger i did lots of supinated (palms up) exercises, biceps curls, writs curls and pull-ups. after the month off i took another month to slowly ease back into things, avoiding consecutive days climbing and throwing myself at compression-style bouldering. ive just come back from a 3 month trip to the states involving 5 days a weeks climbing and only suffered a very mild case on my fourth consecutive day at bishop, which a days rest sorted. that is the only time i have felt anything amiss in the last six months. my diagnosis is that some rest, supinated exercises and a gentle return gave my tendons time to catch up strength wise with my muscles (i could of course be chatting shit, as i have no medical training). fingers crossed for the future.....

[stone]

I'm a fan of "turkish get ups" as a shoulder fixer/ elbow protector exercise.  5mins twice a week seemed enough to help which made it more likely for me to get them done. My impression was that they are ideal for getting the shoulder to work less dysfunctionally and that helps the elbows too.

[Paul B]

It'd be interesting to know if any of the more waif-like members of the board have ever suffered from elbow issues: Paul, Sausage, Dense etc? I reckon Wobble and to a slightly lesser extent Messrs Clifford and Birch of of a body type which will be less susceptible to elbow problems in the first place.

I think I'm about as waifer-thin as they come <9st and I've had elbow problems.
[/quote]

Sorry I hadn't looked in this thread. Basically because I've never had any trouble 
ps - I'm skinnier than him I bet.

[Skinny Pete]

I'm a fan of "turkish get ups" .....

Excuse my ignorance, but what is a "turkish get up"?  I'm guessing it doesn't involve growing a hefty 'tache and wearing a fez and embroidered waistcoat?

PS: Is that Stone the Glossop-dwelling beast?  If so, is that Ford Ka you bought off me still going, or did it explode after one too many thrashings over the Snake Pass?

[The Sausage]

Stone, thrashing it over the Snake?!
He's a self-confessed Granny driver. That Ka will go forever, although it may never hit 3rd gear...

[dave]

It'd be interesting to know if any of the more waif-like members of the board have ever suffered from elbow issues: Paul, Sausage, Dense etc?

I'm not a waif but have had elbow shit in the past. I do some theraband and pressups every day to keep it in check, have done so for maybe the last 8 years. only really comes back if i get lazy and forget for some reason.

[fried]

Thanks Sausage for suggesting the shoulder as being the root of my problems. I've been 'banding 30mins per day + press-ups and my whole arms and shoulders feel less 'twangy' and less subject to random aches and pains for no apparent reason. I haven't pushed the climbing too much, but hopefully if the sun ever makes an appearance I'll find out if this is going to be a permanent solution.

[Richie Crouch]

Theraband and pressups before and after climbing as part of a warmup and warmdown (and also on rest days) have helped massively in the last year. Avoiding intensive campussing for more than a couple of weeks at a time has been another reason for less inner elbow pains.

[Scraggadoo]

I have to say that doing press ups almost every day has helped significantly reduce the pain I get in my inner elbows sometimes when I climb.

I have thought of swimming as one possible way to reduce the chances of this happening. You use your shoulder in quite a lot of its motion in say front crawl or even backstroke with constant resistance through its range of motion in whatever stroke you do. Haven't actually tried it out though but would be good to see if anyone has tried this or if my reasoning is flawed. The sausage seems well informed on these matters so would be good to hear what he reckons to this as well...

Edit: My reasoning is that swimming would help to strengthen the weak areas of the shoulders supposing that this is the root cause of elbow tendonitis

[sidewinder]

Been following this thread with interest, started to get problems with my left elbow after restarting climbing after a long lay off.  As I have a trip coming up soonish I decided to seek some advice and saw John Ostrovskis who works at the place round the corner from The Works.  He diagnosed medial (golfers) elbow as I suspected.
The treatment, cold water twice a day ~20mins, wrist curls as described by the Athlon article , wide armed press-ups with a shrug and a couple of sessions of him working on my very tight shoulder as well as some massage on my elbow tendon and acupuncture (no personal opinion on this but it I have got better fast so am not complaining).

This has worked very well!  I have now switched from cold water treatments to massaging the tendon twice a day (as recommended). I am still having to take it easy on the bouldering front but am able to do stamina type work pain free and apparently without aggravating it.  Interesting from this thread that peoples elbow problems almost always seems to be related to the shoulder.  Since it has been pointed out to me I now realise how tight my shoulder is after a climb, I am hoping that as I continue with the press ups this stops being an issue.

[Rocksteady]

I've been reading this thread with interest as I'm starting to get a sore point on the outside/top of my elbow (lateral epicondriwhatyoumacallit?) which is starting to worry me. I've been doing a lot more bouldering than I used to, and it seems to have brought it on.

What do we know about what causes these elbow problems? From the above shoulder instability is ascribed as a cause, but what style of climbing/specific movement pattern results in the elbow problems?

Is it repeatedly cranking in with the arms, rather than climbing straight armed? Is it shock-loading the elbows with dynamic moves at extension? Or is it a more insidious thing based on individuals' posture/movement style etc?

I guess what I'm getting at is that there are a lot of people who crank hard regularly who don't seem to get injured. What are they doing right that others are not?

[Bernard Jefferies]

It's just that you're cranking hard mate.  Your elbows are dealing with increased load as you climbing harder boulder problems.  It will just be a case of letting your elbows catch up with your climbing I'm afraid.

[sidewinder]

I was told that the problem is that if your shoulder is not working right, it is not helping your elbow as much as it should when you climb, thus more load goes through your elbow leading to the tendonitis.  I imagine the people who crank hard regularly without injury have shoulders that have naturally co-operated.  My physio also said that often these problems often happen if you suddenly increase the volume of your climbing (in particular strength/power work) as the elbow often responds faster than the shoulder leading to an imbalance and then tendonitis.

[Rocksteady]

Want to improve = climb more.

Climb more = elbows and shoulders get out of balance, need to climb less to let 'elbows catch up with climbing'?

Climb less = stay at same level.

Solution = immense patience?!!?

I'm not a mathematician but that is some depressing shit!

[sidewinder]

Climb more = elbows and shoulders get out of balance, need to climb less to let 'elbows catch up with climbing'?

Or climb more and incorporate some of these antagonistic type exercises, push ups, wrist curls etc to help your body adapt to the increased load.

[i.munro]

I was told that the problem is that if your shoulder is not working right, it is not helping your elbow as much as it should when you climb, thus more load goes through your elbow leading to the tendonitis.  I imagine the people who crank hard regularly without injury have shoulders that have naturally co-operated.

Exactly the story I'm getting from my physio & trying to address the shoulder issues seems to have prevented tendonitis re-occurring.

[Falling Down]

Went to see John at The Clinic yesterday morning.  Had a good (if painful) session and he diagnosed nerve compression/irritation of the Ulnar nerve in my 1st and 2nd rib/vertebrae and inflammation at my tricep insertion point which was manifesting itself in weakness in the hand and consequent elbow irritation.  It all sort of makes sense as I've had thoracic spine problems in the past due to posture and too much computer work.   He did some deep tissue massage around my shoulder/1st rib and under the armpit where the tendon insertion point is and it's really helped.

The Tennis Elbow that I had last year was successfully treated by the physio in the Autumn.  Feeling pretty good about things after yesterdays diagnosis and have a green light to climb without aggravating the elbow if I keep doing my stretches and pressups.

[sidewinder]

Just as an update, with the press ups and massaging of the tendon I am now back to climbing to a greater intensity than before the problem started.  I occasionally get a bit of 'tweakiness' during a session, at which point I switch to some easier stuff/stamina circuits and am experiencing no pain the next day.

Just out of interest, does anyone have a definitive answer/opinion(much easier to come by than answers) on how much deadhanging on a fingerboard is likely to aggravate it?  I am still laying off pull ups etc. but like to think that starting some deadhangs on the beastmaker is probably not too bad, however a previous post seemed to suggest fingerboarding is a big no no.

[Falling Down]

Glad to hear you're on the mend.  For me deadhanging is fine but pullups don't feel so good...

[Paul B]

Sorry I hadn't looked in this thread. Basically because I've never had any trouble 
ps - I'm skinnier than him I bet.

Maybe I spoke too soon. I've only had a couple of sessions back but my left elbow has a sharp pain in it when I extend my are fully. Not a great start to starting climbing indoors again 

[Steve R]

Just wondering how people go about massaging the affected area for golfer's?  I bore right in there with my thumb, fingers wrapped over top side of forearm, starting on the epicondyle itself (which often feels tender) then work down a little to where it feels like the tendon attaches.  This is mostly from my own intuition and habit since the physio I saw was totally whack.  Not sure it does anything though I'd like to think the slight pain and discomfort from probing and prodding stimulates some healing.  Just read that athlon article for the 174th time...  Nothing left to improve or new to try as far as I can see  such a frustrating injury!

To be certain, as I've never read or had it confirmed otherwise, is the classic problem area that spot just below (hand/wrist side) of the epicondyle?

Has acupuncture worked for anyone?  My long-term management is sucking so far it seems.......

[sidewinder]

I go for massaging with my fingers, by placing my thumb on top and wrapping my hand fingers round the back, this seems to put my fingers in the right position to massage transversely across the tendon.

I did not however start doing this until a couple of weeks after starting the cold water baths and wrist curls which had reduced the general pain, the rational being that it was probably aggravating it more than helping while the tendonitis was still quite acute.  In fact I only started massaging when the cold water baths started to seem superfluous and I was reducing their frequency.

My physio gave me acupuncture, both in my shoulder, elbow and wrist/hand.  It seemed to help by releasing some of the tension in the tendons/general area allowing him to manipulate it more successfully/with less discomfort.  However even, he, a firm believer said that acupuncture alone is not going to fix the problem, it is the exercises/icing that fix it.

However maybe we could all save some time and just buy some accapi/nexus supports, rather than any of this physio/massaging/icing/exercise bollocks  .

[sidewinder]

Anyone got any good tips for loosening/stretching shoulders?  My elbow is pretty much under control, but the underlying cause (my left shoulder) likes to stiffen up, which, if I am not careful starts the cycle over.  Not yet found a good way to get it to loosen up.