[seankenny]

Don’t know how much you time you spend at a computer but I found a regular mouse really aggravated my elbow tendon issues. Got an ergonomic one which was much better:

https://www.amazon.co.uk/dp/B009D9CZ5C/ref=cm_sw_r_cp_api_i_S7Y3HV0P75TRM6N1BJ5S?_encoding=UTF8&psc=1

[mrjonathanr]

Fiend, again, I’m not a physio, but from my own reading round I’d hazard that the level of pain and amount of damaged tissue may not correlate neatly. ie you may have a tiny volume of damaged tissue but tons of pain- for now, at least. And the volume of tissue which is dysfunctional may not be very important in terms of recovery anyway ie eventually you’ll compensate and recover, whatever.

In my mind healthy functioning of shoulders and everything downstream depends on strength for stability but also good mobility, both are important.

[SA Chris]

Joel - I am considering an armaid. What does it do in terms of muscle / tissue massage that I can't do myself with some fairly brutal application of the other hand (that's talking about dealing with the TE arm, not any other appendage)

For me, i need to hit the "trigger point" where the exact injury is centred. I have an armaid (only because i grabbed it second hand here) and it does it well, but have achieved similar results pushing against a foam roller against a wall, or you could use a rolling pin or similar. You can't (well I can't0 apply enough pressure in the correct place to have effect.

[petejh]

Fiend, again, I’m not a physio, but from my own reading round I’d hazard that the level of pain and amount of damaged tissue may not correlate neatly. ie you may have a tiny volume of damaged tissue but tons of pain- for now, at least. And the volume of tissue which is dysfunctional may not be very important in terms of recovery anyway ie eventually you’ll compensate and recover, whatever.

In my mind healthy functioning of shoulders and everything downstream depends on strength for stability but also good mobility, both are important.

Agree with all of this. Pain can be too subjective like trad grading to be of much use in knowing how bad an injury is. One person’s e5 is another’s e7. Then there are issues around how chronic niggles that stop someone doing what they want to do can cause stress/anxiety/depression, and stress/anxiety/depression can increase perceived pain. Plus those articles describing how the brain adapts to chronic pain and starts mistaking pain signals.
I think most climbers get hurty elbows and they come and go mostly despite all the treatment not because of it. My n1 is shoulder strength and mobility is my go-to along with some mildly painful loading and massage of the area. No idea if it helps or if the tenderness would have subsided by itself.   
Aggravating by diy/manual labour a common story for climbers with hurty joints - ask doylo.

[Fiend]

Fiend, again, I’m not a physio, but from my own reading round I’d hazard that the level of pain and amount of damaged tissue may not correlate neatly. ie you may have a tiny volume of damaged tissue but tons of pain- for now, at least. And the volume of tissue which is dysfunctional may not be very important in terms of recovery anyway ie eventually you’ll compensate and recover, whatever.

Well in terms of volume and mass, the damaged tendon area is going to be very small - but also very important and having a lot of force put through it.

If the proportion of damaged tendon compared to healthy tendon is small, then that would be less worrying. But I can't rely on that guess!

In my mind healthy functioning of shoulders and everything downstream depends on strength for stability but also good mobility, both are important.

Definitely happy to focus on this. Hit me with some shoulder exercise pro-tips....

For me, i need to hit the "trigger point" where the exact injury is centred. I have an armaid (only because i grabbed it second hand here) and it does it well, but have achieved similar results pushing against a foam roller against a wall, or you could use a rolling pin or similar. You can't (well I can't0 apply enough pressure in the correct place to have effect.

Well the exact injury seems to be centred on the extensor tendon, where it meets the lateral epicondyle bone, and slightly down the tendon from that, but not into the muscle body. I can very easily apply enough pressure there for it to be very painful - Process Physio has advised against doing too much of thise (something to do with squeezing too much fluid out of the tendon - apologies if I have mis-quoted that). I have also been massaging further down into the muscle body to try to loosen any tightness there (which is what I've seen an armaid used for) and again I seem to be able to squeeze in a lot of pressure with my other hand. Of course if there's some methodology to the armaid / foam roller other than "digging in really hard and moving the pressure around" then that could be useful.


Petejh: Trad grading is entirely objective as any fule kno, being based on objective facts about the route such as existence of protection, existence of rest points, actual rock quality, exposure, how clear the line is, etc etc. Sport and bouldering obviously are more subjective (i.e. morpho).

hen there are issues around how chronic niggles that stop someone doing what they want to do can cause stress/anxiety/depression, and stress/anxiety/depression can increase perceived pain.

This is very very likely. Plus reduction in climbing / training making my body feel worse (sluggish, stiff, etc) overall. I'm trying to focus on other exercises and mobility stuff to help.

[duncan]

I don't have much to add other than to say joints in general and tendons in particular don't appreciate sudden changes in the amount of loading. Fixes usually include some kind of gradually increasing loading whether it be a twisty bar or Easy Trad.^TM Finding what works best for you usually takes a bit of trial and error.

Pain is an indication of threat. Tissue damage is obviously a threat but the context can make a similar amount of damage a much lesser or greater threat. There are many many examples of where pain is not a good indication of the amount of damage and this seems to be more common when a problem is long term or recurring. If you've had a similar problem before and it meant you couldn't do something really important to you, threat levels go up to red. Clever people also talk about neuroplasticity at this point: crudely speaking we get better at experiencing pain the more practice we've had at it.

General advice is pain when you're doing something is not necessarily a bad thing; if it hurts a couple of hours later or the following morning you've probably over-cooked it a bit.

Hang in there Matt. It might be a small consolation that it's good there was a clear reason why your elbow flared up again. Probably frustrating that it was self-inflicted and done with all the best intentions.

[SA Chris]

For me, i need to hit the "trigger point" where the exact injury is centred. I have an armaid (only because i grabbed it second hand here) and it does it well, but have achieved similar results pushing against a foam roller against a wall, or you could use a rolling pin or similar. You can't (well I can't0 apply enough pressure in the correct place to have effect.

Well the exact injury seems to be centred on the extensor tendon, where it meets the lateral epicondyle bone, and slightly down the tendon from that, but not into the muscle body. I can very easily apply enough pressure there for it to be very painful - Process Physio has advised against doing too much of thise (something to do with squeezing too much fluid out of the tendon - apologies if I have mis-quoted that). I have also been massaging further down into the muscle body to try to loosen any tightness there (which is what I've seen an armaid used for) and again I seem to be able to squeeze in a lot of pressure with my other hand. Of course if there's some methodology to the armaid / foam roller other than "digging in really hard and moving the pressure around" then that could be useful.

The catchall here is as others have mentioned, n=1, and depending on whether the injury is chronic and what stage of the healing process you are at will yield very different results.

I believe with a chronic injury (or one where you have repeatedly injured the same thing) that part of the healing is a build up of scar tissue along with a high sensitivity to pain in the area to prevent repeated injury. Direct massage /presssure will break down the scar tissue and desensitise the nerves. My understanding anyway.

[SA Chris]

Hang in there Matt.

Or don't hang in, as the case may be

[petejh]

Hang carefully on in there? Definitely don't compression on in there Matt.

[Fiend]

It might be a small consolation that it's good there was a clear reason why your elbow flared up again.

Yes. It was getting increasingly susceptible / minorly aggravated over previous sessions bouldering, but I think it was this combination over an evening and following day that was the final straw (on the last problem I was tired from a whole day out and I did feel wary of this move).

Hanging seems okay. Compression seems definitely okay. Locking in on crimpy holds, especially with my arm close to my body (more bodily rotation around that pivot point so more stress locking the wrist to compensate for that, amongst other factors) seems very bad. Dynamic pulls with that arm bad, dynamic catches with that arm okay. Etc etc.


SAChris, your logic there about the injury stage and benefits of massage makes sense.

[SA Chris]

pic 2 looks like waving a red rag to elbow pain; steep crimps, elbows waving, tape!

btw, has tape ever actually helped anyone with an injury like this? I would have though it provides way too little support /pressure.

[Fultonius]

As always matt, purely personal experience, but my video above worked for me but plain massage just aggravated things. I felt like it really helped smooth out the rough damaged collagen and make the tendon / muscle joint more supple. Plain massage gave me no relief and often made things worse.

Have you tried it?

[Fiend]

SAChris - I've found tape to be consistently helpful for alleviating stress on the GOLFER's elbow over various sessions with / without it. Something to do with restricting how much the muscle can pull through that tendon?? I've been using on the TE on that basis but maybe haven't had enough comparative sessions to judge effectiveness.

Fultonious - a while ago I did do that massage on the muscle belly, rather than the tendon injury site, and found vaguely stiff / knotty bits that I managed to soften up. I haven't tried it on the exact injury site but will do.

[SA Chris]

SAChris - I've found tape to be consistently helpful for alleviating stress on the GOLFER's elbow over various sessions with / without it. Something to do with restricting how much the muscle can pull through that tendon?? I've been using on the TE on that basis but maybe haven't had enough comparative sessions to judge effectiveness.

Fair enough, have you tried the tennis elbow straps from decathlon? If tape helps a bit, i expect these would be better. Mine is not needed right now, can post f you want a try.

[Fiend]

Cheers, I did try the epi-clasp thing (as the specific things were called then) when I had bad GE, hated it, really uncomfortable.

[mrjonathanr]

If you have a listen to Jill Cook (not specifically this podcast, but any of her podcasts tbh https://podcasts.apple.com/gb/podcast/05-tendons-and-tendinopathy-with-jill-cook/id454714085?i=1000420118732) you might find it illuminating. In one podcast she talks about Achilles tendon ruptures often being preceded by zero pain despite significant damaged tissue and how similar damage can be symptomatic or asymptomatic with no one knowing quite why some patients have pain and some don’t.

In another-  this bit may resonate, Matt- she talks about patients who get better once they get fed up with ‘repeatedly putting their hand in the fire’ ie stop aggravating the tendon by repeatedly overloading it.

She repeatedly makes certain specific points:

pain is because you are loading the tendon beyond its capacity
the solution is to increase its capacity
Tendons like heavy loads
Tendons don’t like fast movement
The solution is slow, heavy resistance training
Eccentric programmes don’t have superior outcomes (the opposite, in fact) to normal eccentric- concentric loading ie bar raise and lower movements
the sweet spot seems to be 3 sets of 6-8 repetitions at 80% 1 rep max, 3 x weekly, increasing load over time, done slowly eg 5s up, 5s down

None of this is a diagnosis of your elbow pain of course, just her experience of what stimulates tendons to heal.

Alarmingly, she says damage never heals. Think of all the bits of tendon you - or I-  have knackered over the years: they haven’t got better. The surrounding tendon compensâtes just fine. So don’t stress about damage is my takeaway; just get stronger 

*disclaimer: talk to a proper physio*

[Fiend]

.
In another-  this bit may resonate, Matt- she talks about patients who get better once they get fed up with ‘repeatedly putting their hand in the fire’ ie stop aggravating the tendon by repeatedly overloading it.

Do you mean in terms of rehab or management when it's niggly - in which case, yes definitely.

Or do you mean in terms of overloading it when in normal uninjured / barely-injured climbing training - in which case I'm not sure how one gets stronger without heavily loading the muscle-tendon chain?!

Your summary of the general principles of what she recommends goes along exactly with what Process says and indeed with what I've been doing for various injuries.

Alarmingly, she says damage never heals. Think of all the bits of tendon you - or I-  have knackered over the years: they haven’t got better. The surrounding tendon compensâtes just fine. So don’t stress about damage is my takeaway; just get stronger 

Yes most of that makes sense. My LA GE was chronically but manageable injured from 2008 until 2018 (when it cleared up a week after reflexology), during that time I pushed often to my limits when it was manageable. Since it cleared up I've pushed again to my limits (including very GE-sensitive stuff like max bicep curls) with minor reaggravation doing hangs out of the blue in 2021, then major reaggravation being a fucking tool and trying to boulder beyond my limit on steep limestone in the freezing cold in Sept 2021. The point being I concur that these things can "never heal fully'" but heal to a state that is manageable and perhaps completely uninhibitve as long as one is sensible (a theoretical concept for me!!).

As for getting stronger, I seem to bugger it up each and every time I try, despite sage advice from UKB, John Kettle, mrjonathanr, my own self-analysis, etc etc. Evidently not glacially paced enough 

Anyway I just went to the gym again and again it felt fine. Curiously enough, the arm overall feels really pleasant doing barbell overhead press - hard to describe but it just feels "right" on it. Maybe that sort of opposite loading is alleviating some pressure or something...

[mrjonathanr]

Do you mean in terms of rehab or management when it's niggly - in which case, yes definitely.

Or do you mean in terms of overloading it when in normal uninjured / barely-injured climbing training - in which case I'm not sure how one gets stronger without heavily loading the muscle-tendon chain?!

Well, yes, quite! Tendons need both appropriate loading and time to recover. Massively ramping up loads and not having the patience to rest sufficiently is what she means, whether as rehab or just doing sport. Iirc that comment followed a discussion of pre-season training in athletes, who by definition were in a relatively untrained state, but thought they could just bust back into peak season levels of exertion. Doesn’t take long for tendons to start letting you know they aren’t ready.

So I took her meaning as: failing to increase loads slowly and not backing off when there were warning signals that it was too much, too quickly.

The point being I concur that these things can "never heal fully'" but heal to a state that is manageable and perhaps completely uninhibitve as long as one is sensible (a theoretical concept for me!!).

We might be at cross purposes here. She is saying that really injured tendon tissue does not heal at all, it’s trashed and stays that way. The healing we experience is healthy tissue nearby gaining sufficient strength to take over the load. So actually they can, and normally will, ‘heal fully’, it’s just that the damaged tissue just stays damaged. (There are degrees to this, some tendon damage is reversible in early stages, but not once it’s got lots of disorganised cells.)

*Again, disclaimer, this is my understanding of her views, so it’s second hand*

[joel]

Joel - I am considering an armaid. What does it do in terms of muscle / tissue massage that I can't do myself with some fairly brutal application of the other hand (that's talking about dealing with the TE arm, not any other appendage)

Others have already answered this somewhat, but for me (with tennis elbow for clarification) it was incredibly targeted and powerful (with the thing you have a choice of attachments for contact with the arm, going straight to the most rigid one orange ball one was best for me), the trigger point massage was more effective with this device than anything else. The clamping system means that there's nowhere for the painful part of the elbow to hide if that makes sense, it can't squirm around and avoid the pressure being applied. Also it feels like you can apply a lot more force through it than leaning against a wall.

I was kind of tempted to make one myself as it's a lot of money, but in the end I didn't have time or enough skill if I'm honest. It would be possible I think.

Sorry this isn't very scientific as I'm not really like that!  - there's plenty of scientific explanation and evidence posted on this thread which is excellent, and thanks to everyone for sharing experiences and tips, it's ended up being a great resource. Good luck with your recovery!

[tomtom]

One interesting titbit of info gleaned from a Lattice Elbow pain video (sorry - I watched one) was where their resident/interviewed physio suggested that some people get TE/GE when they STOP doing regular exercise that loads the elbow.

This resonated with me - when they have flared a little when I've gone away on a non-climbing holiday for a week or two...

Just to throw into the already confused mix. Sorry.

[DavidM]

I've had a serious bout of Tennis elbow recently that progressed over 6-8months and got worse and worse despite doing various rehab exercises couple times a week it still lingered. It was really getting me down and frustrating. I'm no expert but I can share some tips that help me recover and I did quite a lot of research from various places to get anywhere with it. I have also had it in the past in same elbow which I rehabbed easily with the flex bar but this time that wasn't enough it was so stubborn. What is worse is part for me is that most of my working day my wrist is in an extended position so hard to rest Mon-Fri.

Anyway here goes it may help someone apologies if this details have been mentioned before in the thread

My Symptoms
Classic tennis elbow I had pain pinching whilst climbing, twisting water bottles open and lifting my cast iron frying pans while cooking. It got worse that I lost quite a significant amount of strength in that hand and had to address it and take a rest from climbing to get it sorted once and for all.  Arm bent on my 50 degree board aggravated to so sounds fairly similar situation.

I continued to train to keep sane with a bar, rings, core exercises and careful finger boarding with hands close together on the fingerboard to avoid the bent elbow which cause strain into the elbow joint. If the fingerboard is aggravating drop this for a while.

Adjustments / preventions
-Avoid lateral raises or lifting weights with extended straight arms. You can still do these exercises but have thumbs point up rather inwards but best to avoid for a little while.
-Push ups with neutral grip position on rings.
-Try to do any weight, rings or TRX exercise with modified neutral grip position where possible.
-Use computer mouse in the other hand to the one with the injury
- Avoided pinching all together whilst climbing / training and minimise in daily life where possible
-Avoid icing
-Avoid Ibroprufen

What worked for me

Massage (aggressive and regularly)
-Aggressively massage of the tendon area. Regularly I massaged the tendon where it was most painful at the elbow and down towards wrist but mainly focussing 90% at the painful bit near the bone. Standard cross friction in two areas one near the bone on outside of elbow and one just above the crease at elbow on the top near the bone. My weapon of choice was a wooden spoon using the spoon end with a little oil or cream to get into the bit on the outer side of elbow and the pointed handle end to dig into the area just above the crease of the inside of the elbow (this was the area that was painful when arm was bent on wall locked off and doing rotator cuff exercises). Massage along the extensor muscle from elbow to wrist to relax that area to.
- Pin and stretch exercise

-There is another version of pin and stretch where you hold the painful area of the tendon and just rotate your wrist back and forth like turning a door knob.

Eccentrics

Now this is the area which caused the most confusion for me and lack of progress. The key take aways with this is to really read Dr Julian Saunders article very, very carefully as I spent time doing wrong.
http://drjuliansaunders.com/ask-dr-j-issue-223-dodgy-elbows-revisited/
We all know of this article but the devil is really in the detail to get this sorted. One thing he doesn't mention is that you need to do this a lot I mean a lot for it to work if your injury is stubborn and been around for a while.  3 sets every other day isn't enough. To make head way with my injury I was doing 9-12 sets (morning, midday, evening) 6 days a week for 3 weeks before I broke a plateau so you just have to stick with it diligently. Whilst in this article he shows you one exercise for tennis elbow which was my bread and butter but I decided to add others and I found that helped to in different way. Again eccentric loading method at various angles to maximise benefit.
Wrist Deviation – (The “hammering” motion)
And Wrist Extension – (The “ringing-out-wet-towel” motion or the direction of opening your hand if your wrist follows your fingers backwards) 

Key take aways
-Adjust elbow angle to get the most benefit. I got most benefit from my arm bent almost at 90 degree
-Don't start to lower the weight with it pointing directly up (12 o clock) but it needs to be pointing at 10 o clock for right hand and 2 o clock for left hand. Lower from there slowly 5 seconds
- Do way more sets than directed but keep the weight heavy
-Aim for failure on the last either 3rd or 4th set using heavy weights
-Keep increasing the weight as you feel your not reaching failure and getting stronger
-Try the other wrist motions wrist deviation and wrist extension to hit other areas.
-Once you get stronger add in the concentric portion and lift the weight back up. Go heavy

Power fingers
-6 sets 3 morning 3 evening 20 reps almost failure on last set

Other exercises that weirdly helped me (day after elbow felt better) not sure why.

-Kettlebell swings
-One arm ring rows again neutral grip

Apologies for lengthy post hopefully someone will get something out of it to help them.

[largeruk]

@DavidM

Many thanks for your helpful post. I've read the Sanders article and tried to relate your words to it but still failing to clearly understand the eccentric exercises you've described. If it's not too much bother, could you possibly add video links showing the specific exercises? I think my visual brain might comprehend a little better  .

[Fiend]

Cheers for the further replies.

Joel - I can massage strong enough to get quite a bit of actual pain (not discomfort / tenderness) from the pressure at the injury site itself so I might be able to do enough, if massage is right for it, without an armaid.


Tomtom - it isn't a sudden decrease in general loading this time, although I'm wary of that, (using mrjr's "keep weekly load withing 80-130% of previous week" - badly paraphrased I know - principle). Obviously I have to now decrease the load as the previous overload (~2 months of probably okay load on aggravated elbow culminating in ~2 weeks of overload when it had got too much). I'm still trying to figure out a point when I should have just stopped / eased off, it's actually quite a bit harder this time compared to when I initially aggravated both elbows on the board-gym-gym-board debacle.


DavidM - that's some interesting information, although I am wary of the amount of loading there (in the context of talk about overloading risks above). I will be raising all options when I see Process next.

[DavidM]

larger uk

One being the standard wrist extension exercise here


Second being the one outline for tennis elbow in the Saunders article

The other one helped me is the hammer style motion here label radial deviation. This one hits the right tendon but not as directly as the two above so it nice complementary exercise that builds strength but doesn't overload.
https://www.thepronator.com/how-its-used/exercise-chart/

The difference is these exercises are done with arm pit against the table as described by Saunders in his article and varying the angle of the arm from straight to 90 degree. For a long time I was doing them sitting down with elbow on my knee and they didn't work. Really find the elbow angle that cause aggravation and start working there. I ended up doing them on the sofa with my elbow resting on the horizontal sitting part at head level and legs laying beside me half laying down if that makes sense. Hard to describe but I had more pain when pinching for example with a bent arm so I worked a lot with a bend arm during the exercises. Second important tip is not to let gravity hold the weight up at it's starting position. When you use the other hand to pull the weight back up don't pull the weight all the way back so gravity isn't assisting its starting position. Bring it back 60% so when you start the rep the tendon is already under tension. This way the tendon is under tension a lot more during your reps and sets.
In terms of the power fingers I even do the power fingers with bent arm with wrist extension for specificity to. On training days in between core exercises and strength training I did more sets and next day it feel even better.

Fiend
I think my breaks through came when I stopped over loading it with climbing which is a lot less controllable and concentrated on this directly and loading it frequently to start with lighter weight high reps and as it gets stronger heavier weights less reps and adding in concentric portion with the eccentrics. You have to get past the first couple of weeks where nothing feels like its happening even feels slightly worse at times and trust the process. You have to overload it in a sense for it to rebuild and get stronger but in a controlled manner. As I said continued to train around it using strength exercises that didn't make things worse.

[DavidM]

Youtube video not sure why it errored