[Andy W]

I'm wondering about this. I've had bicep pain in the bottom of both biceps for well over 12 months. I think I did the injury from deep locks on a campus board. I've done lots of eccentric bicep curls and stretching, with I would say not much improvement, whilst also avoiding all deep locks/campus boards etc.

This week I've tried doing some deep locks and uneven pull ups, the first session was ouch! at the time, but fine straight after and the next day, second session was less pain and the same result after. I wonder if months of doing eccentric curls and no real pull up type stuff (concentric) was counter productive or worse?

[TobyD]

I wonder if months of doing eccentric curls and no real pull up type stuff (concentric) was counter productive or worse?

pure eccentrics are somewhat discredited by the most recent research into tendonopathy rehabilitation in favour of concentric/ eccentric regimes, which your experience appears to support.   

[Sasquatch]

pure eccentrics are somewhat discredited by the most recent research into tendonopathy rehabilitation in favour of concentric/ eccentric regimes, which your experience appears to support.   

 

Where have you seen this??? Any references?

[TheTwig]

I wonder if months of doing eccentric curls and no real pull up type stuff (concentric) was counter productive or worse?

pure eccentrics are somewhat discredited by the most recent research into tendonopathy rehabilitation in favour of concentric/ eccentric regimes, which your experience appears to support.

First of all.... you injure your biceps and so do lots of exercises on.....your biceps. go figure! Unless it's a cut-and-dry case of tendonitis of the elbow (golfers or tennis, which are both easy to self-diagnose IMHO) then you are best off going to see a doctor or physio who can work out what is wrong.

That said I have no idea what TobyD is on about.......literally all the research I have seen on tendonosis conditions since I started looking into it have all supported the idea that eccentric exercises are the best thing ever. Dave Mac talks about them in his injury book, Eric Hurst in one of his, plus the tyler twist style studies and associated anecdotes. Then there is the body of evidence for eccentric exercises for achilles tendonopathy. 

[Andy W]

I wonder if months of doing eccentric curls and no real pull up type stuff (concentric) was counter productive or worse?

pure eccentrics are somewhat discredited by the most recent research into tendonopathy rehabilitation in favour of concentric/ eccentric regimes, which your experience appears to support.

First of all.... you injure your biceps and so do lots of exercises on.....your biceps. go figure! Unless it's a cut-and-dry case of tendonitis of the elbow (golfers or tennis, which are both easy to self-diagnose IMHO) then you are best off going to see a doctor or physio who can work out what is wrong.

That said I have no idea what TobyD is on about.......literally all the research I have seen on tendonosis conditions since I started looking into it have all supported the idea that eccentric exercises are the best thing ever. Dave Mac talks about them in his injury book, Eric Hurst in one of his, plus the tyler twist style studies and associated anecdotes. Then there is the body of evidence for eccentric exercises for achilles tendonopathy. 

I injured  my biceps and did pretty much what I figured was the right thing, laying off the stuff that caused the injury, rehab with concentric exercises etc. So I don't get your 'go figure comment'. If you have say elbow tendonosis, you do exercises which involve your elbow.

I'm just wondering if you can focus on eccentric to the extent that the injured  area can become 'damaged' so to speak from under use. No idea what I'm talking about obviously, but today after two sessions of deep lock etc, the bicep pain is the same, not worse.

[abarro81]

If you have say elbow tendonosis, you do exercises which involve your elbow.

Typically, if you have golfers or tennis elbow you do eccentrics which involve wrist flexors, with a static elbow position. I've never had the above-the-elbow type pain so don't know the rehab, I know others on here have so they might be along to help. Off hand I'd have thought any bicep work would be likely to aggravate it though and stuff like press-ups would be more likely to be useful.

[rosmat]

[quote author=TobyD link=topic=25837.msg487632#msg487632 date=1431729143
pure eccentrics are somewhat discredited by the most recent research into tendonopathy rehabilitation in favour of concentric/ eccentric regimes, which your experience appears to support.
[/quote]

Toby, I think I know what you are trying to say, and you are correct, unfortunately it was a poor choice of words - which makes your statement a little misleading.

It's not that pure eccentric regimes have been "discredited", but rather that some research has found a combination of both eccentric and concentric protocols to be more effective than simply eccentric alone.

[lmarenzi]

Andy

a few questions about your original post

1. what kind of lock offs are you doing, and why? I remember Eva Lopez looking at lock offs in a three part series and concluding, after many caveats, that they are a waste of time at every level?

2. eccentrics are recommended for elbow problems but you seem to have a bicep problem. What did the physio/doc say?

3. what eccentrics were you doing? There is no concentric move for a lock off, it's static, so how can there be an eccentric move?

[Andy W]

Andy

a few questions about your original post

1. what kind of lock offs are you doing, and why? I remember Eva Lopez looking at lock offs in a three part series and concluding, after many caveats, that they are a waste of time at every level?

2. eccentrics are recommended for elbow problems but you seem to have a bicep problem. What did the physio/doc say?

3. what eccentrics were you doing? There is no concentric move for a lock off, it's static, so how can there be an eccentric move?

Hi Ok I'll try and explain, over a year ago I did some campus work including starting on bottom rung and bumping up one hand to 2, 3, 4, 5 etc, can't remember what they are called, but in effect it involves leaving the lower hand/arm in a deep lock. Pretty sure this brought on the injury.

No doc or physio has come up with a diagnosis, a scan revealed mild shoulder tendinosis in both right and left. My self diagnosis is some kind of bicep tendon(something).

The exercise I've done a lot of is lowering a dumbell, ie reverse bicep curl. I've done a years worth of these. This is where I got my info   http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3414073/

[Boredboy]

That's for distal bicep tendinosis, I don't think eccentrics have been well evidenced in proximal long head of bicep tendon wear at the shoulder. I can understand why it might stir it up.

[tomtom]

I thought this thread was about how I feel when I walk into the tea room at work...

[Fultonius]

Wait a minute here... Diagnosis of mild shoulder tendinosis and pain at the lower biceps. How well can you pinpoint the pain? Is it sore to touch or just generally achey? Have you considered the possibility of referred pain from imbalanced shoulders?

[duncan]

If any treatment has not been working after a year of trying it's clearly time to do something else. It'll try to explain why eccentric exercises might not be the most appropriate for climbers in another post but, briefly, I'd be looking at your shoulders and shoulder stability. If pull-ups seem to help then definitely try these, focus on keeping good form throughout, especially during the lowering phase. There may well be other factors involved but these are hard to assess via text reports.

[duncan]

It is clear appropriate mechanical loading (not too much or too little) is good for tendons. The jury is still out on whether the load needs to be eccentric, concentric or both, particularly for climbers.

I was always puzzled as to why eccentric exercises were suggested as being good for tendons. How can a t​endon​ know if its muscle is working eccentrically or concentrically? The golgi tendon organ is stimulated when the muscle generates force, it cannot differentiate between concentric and eccentric contractions. Experimentally, it is not clear that eccentric is better than concentric exercise for tendonopathy. Clinical trials comparing the two protocols are few, underpowered and generally of moderate or low quality (e.g. Larsson et al 2012, Kingma 2007, Woodley et al 2007).

Recently, there have been interesting discussions around the effect of weak calf muscles on the achilles tendon. In people with achilles tendonopathy, the calf muscles 'judder' under heavy eccentric loading, typically as you land when jumping or running. This juddering - the muscle rapidly switching on and off as it struggles to cope with the load - is thought to briefly produce much higher forces on the achilles tendon. Counterintuitively, weaker muscles may result in larger, potentially cumulatively damaging, forces on the tendon. This is all a little speculative at present but it's an attractive idea. It therefore makes sense to train the calf muscles for the highest load they need to cope with, i.e. with repeated brief duration heavy eccentric contractions. Most clinical experience and research is in Achilles and patellar tendonopathy using this kind of protocol.

It is possible something similar is happening during tennis backhand shots, repeated heavy eccentric loading during backhand shots combined with weak wrist extensors resulting in 'tennis elbow' and similar with the flexors during forehand shots for 'golfers elbow'.

It is much less clear the same reasoning, and hence the same rehabilitation protocols, should be applied in climbing. Climbing mainly involves static or concentric loads. Climbers typically describe deep locking positions as aggravating. This doesn't suggest an eccentric loading protocol is likely to be most effective and the OP's experience supports this.

(Is the eccentric phase of pull-ups the reason why they are such a notorious exercise for climber's elbows? Climbing mainly trains us concentrically - pulling up - so do we struggle with the eccentric phase of pull-ups, the lowering down?)

Dynos could be one time when our muscles work eccentrically. Some people appear to initially catch holds in a half-crimp position then allow the hand to open slightly to absorb the load. This suggests the deep finger flexors work eccentrically. It would interesting be to film the hand and forearm in high frame-rate, and analyse the movement in slow-motion.

Take home messages? As usual, rehab. needs to be specific to the activity. If campussing or dynoing gives you problems, then heavy, fast, short-duration, eccentric work might be appropriate. If deep locks are the issue, look elsewhere. Shoulder stability for example.

[lmarenzi]

Last question would be how has the injury impacted your actual climbing?

Lot's of thought provoking input above. Not much too add but would say, as a preliminary

1. Stop doing the particular campus routine that you think hurt you. Plenty of other useful training to do on the campus board and elsewhere.

2. If your chosen rehab is not working within a reasonable time frame then you need to vary the intensity or frequency up and down and, more likely, find another protocol which hits the spot.

[Andy W]

What prompted me to post was that I have been avoiding the type of routines that I think gave me the injury for over 12 months, plus doing reverse bicep curls and press ups, not all the time of course. Recently the last two months I've lost a bit of interest and discipline in rehab, I guess because it didn't seem to make much difference.

Last week I did two routines of deep locks and uneven pull ups which caused no increase in discomfort.

I've also noted the idea that the problem may lie in the shoulders. If I lived somewhere other than deepest Cornwall I would visit a physio.

cheers

[TobyD]

It is clear appropriate mechanical loading (not too much or too little) is good for tendons. The jury is still out on whether the load needs to be eccentric, concentric or both, particularly for climbers. ... As usual, rehab. needs to be specific to the activity. If campussing or dynoing gives you problems, then heavy, fast, short-duration, eccentric work might be appropriate. If deep locks are the issue, look elsewhere. Shoulder stability for example.

thanks Duncan, that is more or less what I should have posted a few posts ago; indeed several of the key papers usually cited to support pure eccentrics a) done with repect to achilles tendonopathy b) done on rabbits?  I'd guess that elbow pain in climbers may well be as likely due to thoracic posture,or shoulder instability / protraction as a local elbow pathology.

[TheTwig]

Another point, you mention loss of motivation/discipline in the rehab, what was your compliance like? I had/have tennis elbow in both arms and initial rehab with spotty compliance didn't do anything other than reduce the pain to a somewhat more manageable level. Once I got more into a routine of doing my rehab work I got much better results (this took months!). D Mac also mentions in his book for overuse type injuries often it hurts the most just before it gets better (i can vouch for this)

[benno]

I was always puzzled as to why eccentric exercises were suggested as being good for tendons. How can a t​endon​ know if its muscle is working eccentrically or concentrically? The golgi tendon organ is stimulated when the muscle generates force, it cannot differentiate between concentric and eccentric contractions. Experimentally, it is not clear that eccentric is better than concentric exercise for tendonopathy. Clinical trials comparing the two protocols are few, underpowered and generally of moderate or low quality (e.g. Larsson et al 2012, Kingma 2007, Woodley et al 2007).

I'm aware this isn't exactly scientific, but as you've already pointed out, the science here isn't cut and dry yet, anyway. One plausible theory I heard for this was that although your tendons can't tell the difference between concentric and eccentric loads, your muscles can and can take higher loads eccentrically at a fixed level of effort. So, the theory goes that it's possible to give your tendon a strenuous workout that doesn't stress the muscle as much as the comparable concentric workout would, and in this way you can train your tendon to "catch up" with the muscle. I suppose this assumes that the cause of such things as golfer's elbow is the muscle being relatively "too strong" for the tendon, which the other work you talk about would appear to dispute, but it's an interesting idea nonetheless.

[Boredboy]

"How can a t​endon​ know if its muscle is working eccentrically or concentrically? The golgi tendon organ is stimulated when the muscle generates force, it cannot differentiate between concentric and eccentric contractions."

How do you know it can't?

[TheTwig]

"How can a t​endon​ know if its muscle is working eccentrically or concentrically? The golgi tendon organ is stimulated when the muscle generates force, it cannot differentiate between concentric and eccentric contractions."

How do you know it can't?

 

There are a zillion different theories about how tendonopathy develops.

Just the ones I know about:

- Imbalances between pairs or groups of muscles
- acute injury not being allowed to heal
- repeated loading at certain joint angles (eg deep lockoffs)
- stress shielding (some parts of the tendon are stronger/weaker than others)
- chronically tight muscles constantly loading the tendon
- 'adhesions' / gluey fascia etc etc etc
- repeated shocks/vibrations causing damage to the tendon that do not heal (one of the main theories with tennis players I understand)

those are just the ones I can think of off the top of my head, there are probably a zillion other theories. It's a developing field. If a treatment works what's the point trying to pin down the exact mechanism over the internet? This is the study that seems to have pretty much started the ball rolling with public awareness of how to treat Tennis Elbow for example - http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2971639/