[saltbeef]

went to the physio yesterday. was quite informative. showed me an article about tendonitis where they biopsied the tendon, this showed that tendonitis is not caused by inflammatory changes it is in fact degeneration. this implies that training the elbows too hard (like I do) causes the tendons to break down whilst trying to remodel rather than causing inflammation of the sheath which is the earlier understanding. anyway my elbows still aren't right. bugger.

[a dense loner]

could have told you this by logic, but remember copernicus, inflammation of the sheath my arse, have never beleived such tripe. sometimes you just need to ask someone who has no vested interest in a particular field   :oldgit:

[runt]

D'you find if you've been neglecting the bench your elbows hurt more? Thats how my arms seem to play up, figure that one out?

[erm, sam]

"breakdown whilst remodeling" I would understand this to mean that the tendons don't have enough time to recover between intense training sessions, leading to a gradual decline in tissue quality.

Seems kind of obvious. Not in a "duh you thick bastard" way, just in a "aha, of couse, makes sense when you put it like that" way...

[saltbeef]

runt, by the bench i assume you mean, bench presing... that would make sense. as you're working the climbing agonists, but the bench will work the antagonists, ie even out the muscle imbalances that turn you into a hunchback. an interesting thing about rest; sitting in front of your computer is not resting because of the way you sit and place your hands on the keyboard, exacerbating what climbing does to you.
i get what you're sayin sam

[moose]

an interesting thing about rest; sitting in front of your computer is not resting because of the way you sit and place your hands on the keyboard, exacerbating what climbing does to you.
i get what you're sayin sam

that makes sense - I'm plagued by wrist and finger "niggles" that I'm fairly sure originate from climbing.  But, they rarely actually hurt during a climbing session - mouse clicking and typing appears to be what aggravates them.

Best injury cure I have ever had though was moving to a shoddily built house.  I can no longer be tempted to do batches of 30 chin-ups from the kitchen door frame everytime I pass through for a cup of tea etc.

[saltbeef]

here's some hardcore training... http://www.american-gymnast.com/tt/strength/circuits/upperbody.htm
don't know if that works as alink cos i'm a luddite... makes you feel very weak.

[r-man]

this showed that tendonitis is not caused by inflammatory changes it is in fact degeneration. this implies that training the elbows too hard (like I do) causes the tendons to break down whilst trying to remodel rather than causing inflammation of the sheath which is the earlier understanding. anyway my elbows still aren't right. bugger.

Yep, that's what I've come to realise through trawling the net for miracle cures.  :roll:

...Though your physio is showing you slightly dodgy information if he's telling you that tendinitis is not caused by inflammatory changes - the itits on the end of the word means inflamation - so tendinitis is by definition tendon inflammation. The degeneration of the tendon is actually called tendinosis, of which tendinitis is a symptom. So your physio is technically right that tendinitis may be caused by tendon degeneration, but it aint the same thing, as lots of people seem to think.

I aint no doctor, but being prevented from climbing does make you very interested in the reasons why. Check this out:

Hmm, here's something about healing tendons that's quite interesting (if a bit long-winded)


Quote:Experience suggests that resolution of tendinitis can be surprisingly time-consuming. The reasons can be found in the pathophysiology of tendon repair. Following flexor tendon laceration, tendon healing follows three phases. Initially, inflammation is observed, This stimulates migration and proliferation of fibroblasts and the removal of damaged tissue. The inflammatory phase ends long before tissue remodeling has been completed. Within the first week, collagen synthesis is initiated, though fiber orientation may be chaotic. By the fourth week, fibroblasts predominate and collagen content increases. Maturation of collagen and functional alignment occurs by the second month, with maximum functional restoration requiring exposure of the healing tendon to renewed loading. Exercise and movement are fundamental to the therapeutic process of an injured tendon. But premature exercise can be detrimental; movement of a deformed, devascularized, or inflamed tendon will provoke further injury and breakdown. Mechanical loading that results in a stiffer tendon development can provide structural integrity but a loss of mobility. Pain is an important indicator of either gross or microscopic abnormal tissue responses. In considering MSDs involving tendon and ligament it is especially important to differentiate between aggravation of an injury and exercise, which can be therapeutic. Exercise has proven to be an important component in the remodeling and strengthening of the ligaments of the rat knee. However, tendon and ligament adaptation and repair are inevitably slow processes -- a knee injury can take up to 2 years to fully repair. Thus, although tendon, in particular, can effect a considerable but slow adaptational response to increased physical demand, a progressive increase in loading demands can easily exceed remodeling capacity, increasing the likelihood of re-injury. The slow natural rate of tendon and ligament repair also highlights the importance of prevention and early intervention. Established injuries can persist for weeks and months even after ergonomic review of the workplace and remediation.


lots more long words at this site
http://www.ergonext.com/aa-science-msd/tendons-ligaments.htm

Though this is more concise:

Quote:In cases where the tendon is inflamed (tendinitis), conservative treatment is usually only needed for three to four weeks. When symptoms are from tendinosis(tissue degeneration due to overuse), you can expect healing to take longer, usually up to three months. If the tendinosis is chronic and severe, complete healing can take up to six months.


More words and Pictures here:
http://www.handuniversity.com/topics.asp?Topic_ID=4

from this thread, mostly about alternative therapies and drugs:
http://ukbouldering.com/board/viewtopic.php?t=3324&postdays=0&postorder=asc&start=0

[a dense loner]

I aint no doctor

but saltbeef is

[r-man]

Blimey, is he?

Saltbeef, I'm curious - having been (rightly or wrongly?) warned doctors don't have enough specialist knowledge to deal with this sort of thing, I never went to a doctor, just a physio (who didn't really help). So what's the usual way doctors diagnosis and deal with with tendon problems?

[saltbeef]

right, here lies the problem... it all depends on whats going on, where you live and whether you want to pay... there is a small group of specialists who deal with sports medicine, now these are sports physicians and sports surgeons. now when i get up in the morning i think, coffe then climbing a surgeon thinks mmmm how great am i and what can i chop up. (thats a generalisation.) i met one sports physician in barnsley, this guy knew his shit. but i think they're a rare breed, he'd trained as a doctor and as a physio, and had a msc in sports science. but i only spoke to him for about an hour. he was really spot on about conservative treatment, ie not cutting you up.
to answer your question, i would suggest you see a physio who is a specialist in sports injuries. now as with everything in life you'll get good and bad physios. (and good and bad doctors but i didn't say that.) so if you want good treatment you need to do your homework and don't expect it to come for free ie on the nhs(physio's in the nhs tend to have far more important things to do than worry about us dickheads who don't rest, like clearing cystic fibrosis sufferers chests.) so look them up ask around and go to hallamshire physiotherapy in sheffield and get alison macfarlene or steve gough.
that still didn't answer you. a doctor and a physio will take a history and examine you. its unlikely you'll get much on the nhs. unless you really fuck yourself and don't expect to get masses of amazing rehab. you'll have to pay cos all nhs money goes towards managers.

[saltbeef]

ok and to answer you about tendonitis. i believe the article was by kahn and was in the bmj and was about achilles tendonitis but the premise is the same, i did find it this morning, but didn't write down the ref.
 ok in medicine there are alot of misnomer's and there is a lot of stuff where they're is a very vague amount known. i realis the suffix itis would imply inflammation; however if you take cancer as an example the suffix carcinoma implies malignancy  and oma a benign neoplasm but melanoma is a malignant neoplasm of the skin.

so... i'll reach my point, originally it was thought that tendonitis was caused by breakdown of the tendon, ie ripping it apart and the ensuing inflammation that is an attempt to rebuild and warn you that you're fuct lead to swelling in the sheath leading to impingement on the nerve and activation by prostaglandins causing pain.
the theory (and it is all theorry) is that as you train your tendon remodels, there are various stages of this but basically you breakdown bwfore you rebuild, and this is what happens in "tendonitis" more breakdown than rebuild. so DON'T get steroid injections as this will cause further catabolism(breakdown, i just wanted to use that word) oh and sit up straight.

[Paz]

That's impresive

[runt]

Blimey dr beef, you were paying attention in lectures! wish my gp had been. Yeah I meant bench pressing, although can't do it very well. All that tendon stuff is well interesting but nuts, I'm kind of glad I don't know what I'm doing when I climb, it must do your head in!

[r-man]

Aye, cheers for that reply, was very interesting. Good to hear it from someone who knows rather than having to rely on what I've managed to figure out from the net.

The physio I went to see was a sports physio, though I'm not sure he knew all that - or maybe he just didn't tell me everything he knew. Anyway, I couldn't afford to go for more than 3 weeks - and the advice of keep climbing but try to take it easy didn't seem to be working. He reccomended short hard climbing rather than long sustained routes - seems a little odd to me. My arm is starting to feel better after about 8months, but the only thing that has worked is just not climbing - sensible to a non-climber perhaps, but bloody annoying to an addict.  :wink:

So what are the best ways of avoiding "more breakdown than rebuild"? Does warming up make a significant difference? Or is it a case of just saying there is only so much training you can do, you just have to find the right balance?

[saltbeef]

well, do as i say not as i do. dylan knows his shit so he'll have something to say. i reckon some people are far more prone to injury than others. i seem to get injured once a year, which is fucking irritating. last year i fared fairly well with only a niggle in my elbows.
anyway, do press ups, these help even out your muscles a bit, get a thera band, hold it straight out in front of you and then move your arms so they're straight out sideways. you should feel it in your upper back, look at you posture and try not to become a hunch back. that sounds stupid but look at most climbers, this'll keep your joints and muscles in the best anatomical position and spread the load. i think warming up and warming down is important, do some skipping think of rocky and you'll get psyched. stretch, and keep your arms flexible. get good amounts of rest, drink lots of water, take glucosamine and chondroitin. and stop when your fresh. (i nver do this hence...) otherwise you'll be just slumping onto your tendons. oh and stay light. look at the litle whippets they're never bloody injured but make sure you eat quality food (not tesco's finest) but fresh fish, fresh veg, fruit.
if i think of anything else or if you want any more info let me know.

[a dense loner]

i said he was a doctor, i didn't say a good one

[Johnny Brown]

look at you posture and try not to become a hunch back

Ah, that explains why saltbeef walks around sticking his chest out all the time.

[saltbeef]

no I'm just a jumped up twat

[saltbeef]

and r-man you don't wanna be crankin boulders like your physio said you  wanna be doing easy routes for a bit. (like sardine, which is what i shall be climbing for the next 2 weeks before i go to south africa...)

[Terrace Ghost]

You need to rest Saltbeef, training 23hrs a day is never good.

[a dense loner]

when will saltus beefus ever take his own advice? answers to be 5 letters long and ending in ever

[webbo]

when do medics listen/take their own advice.


i know this for a fact.


trust me i'm a nurse. :lool:

[a dense loner]

i always thought you were a bloke, that's stereotypes out the window then

[webbo]

i always thought you were a bloke, that's stereotypes out the window then

i always thought i was a bloke as well.i thought the stereotype thing was male nurses,hair dressors and interior designers.