[LongMonkey]

I've been getting physio for my elbow (inside of the elbow, golfers side) which has been a problem for most of this year. I've now come to the end of my treatment with no real improvment. My physio can't do anything more for me. We both agreed that the next step would be to consider a cortisone injection. I've read up on it but am unsure whether it will really help. Has anyone had a cortisone injection and did it help at all? Any feedback would be great. Any alternatives?`

[ned]

I know someone who has had them in both elbows. They reckon they really help once you have got over the initial pain of having the injection!

[r-man]

I read up on this a while back when I was having big problems with my elbow. I can't remember the specifics, but I came away thinking it was best to steer clear as you can cause a lot of damage.

Cortisone gets rid of the pain temporarily, but I don't think it really solves the problem, so people often go back for more injections, which can cause a lot of damage. Am I right in thinking all they do is reduce inflammation or something like that? Inflammation is a sign you need to rest and let your tendon repair itself. This can take a long time (longer than muscle or bone - tendons don't have a good bloody supply).

If your tendons are really bad (mine was) then you need to stop climbing and putting stress on it. Depending on how bad they are, it might take a few weeks, it might take months.

I went to a physio for a while and to be honest he didn't really help. Advising continued excericise is all very well if you can really discipline yourself to climb only on jugs and not stress your tendons in any way for a few months, but I found it's next to impossible in climbing, especially outdoors. You just need to stop and let your tendons heal, however frustrating it is.

That's my tuppence worth. Just a personal opinion.

[erm, sam]

I would suggest trying another physio before you resort to injections. I have had problems that one physio was unable to help with, whereas another did sort it out. Or try an oesteopath, for a different approach.
There are some threads here about decents pshysios with experience of these matters.
Good Luck

[Simon S]

I've had a cortisone injection in a finger, and it really made a massive difference. The pain and inflammation was eradicated. The problem as I understand it is that the injections have been linked to ruptured tendons. I beleive this to have been the case with runners and lower leg injections.
My opinion, for what its worth, is that they are a last resort after everything other option has been exhausted. Have you tried dips, press ups, shoulder presses, bent over kick backs etc. My aunt, who is a physio reckons that many elbow/tendon problems are caused by shoulder weaknesses/imbalances.

[LongMonkey]

Yeah, it's an anti-inflammatory drug but repeated injections can weaken the tendon which it's good new as it can lead to further problems. This is my main conern. My doc is pretty good and I plan on looking at alternatives before commiting to it. Cortisone is a bit of a dirty word in climbing circles although the physio I was seeing said that it has helped people to full recovery afterwards.
Thanks for the feedback, positive and negative views all welcome.

[LongMonkey]

An alternative to the dreaded injection maybe?

http://www.prolonews.com/what_is_prolotherapy.htm

[dobbin]

My friend had a cortizone injection after physio for golfers. The cortizone made it feel loads better although it wasnt actually recovered - this meant he climbed on it again and ended up having to have surgery. In the surgery, they scraped away all the scar tissue and he had to completely rehab it from day 1 again.

I have more or less recovered from golfers at the moment, largely thanks to about 5 sessions with a very good chiropractor. He's in harrogate and costs £25 a time, but I am quite convinced as to how good he was!

[LongMonkey]

According to my physio I've been doing all the right things. I rested for nearly 3 months, then used an elbow clasp, been using one of those Metolius squeeze balls, stretching. I've done eveything apart from dips. Thanks Simon, I read about imbalances in the elbow too and worked the opposites of squeezing and done press ups, triceps raises etc but still have this pain on the inside of my elbow right on the Ulna bone. That's why I'm considering a Cortisone but am put off by the bad rep it's got. Found this treatment called Prolotherapy (see the link above). Gonna speak to my doc about this.
Thanks all, keep it coming.

[r-man]

Hmm, your link leads to a description that begins like this:

The basic mechanism of Prolotherapy is simple. A substance is injected into the affected ligaments or tendons, which leads to local inflammation

Is it just me or does that sound lke a VERY BAD idea?

It took me a lot longer than 3 months to recover from my tendon problems (I still have to be very careful and it's over a year now).

Out of interest, have you got a sports physio, or one that actually has experience of climbing injuries? I know they reckon a sports physio should do the trick, but mine didn't, and most people who praise their physio seem to be praising ones who regularly treat climbers. I could be wrong, but if you are paying 25-30 quid a go, it can't be bad to shop around.

[LongMonkey]

So your saying it's no better than a cortisone injection? I think if you read more than the first line of the second paragraph it actually makes sense in a homeopathic way.
As soon as I experienced pain in my elbow I stopped climbing completly for 3 months then started exercises then light climbing and physio. In total I have been out of full-time action since May.
Your right though. The physio wasn't a sports injury physio so might not have got to the root of the problem.

[r-man]

I'm no doctor, but the whole thing sounds a bit dodgy to me. Take this for instance:

This incomplete healing results in these normally taut, strong bands of fibrous or connective tissue becoming relaxed and weak. The relaxed and inefficient ligament or tendon then becomes the source of chronic pain and weakness.

I was under the impression that problems occur because inelastic scar tissue forms, and pain is caused when it tears. And that climbers tend to push their luck by going back too soon, before your tendon has sorted itself out. Or something.

Anyway, what I was actually trying to say about physios was that a sports physio may not be good enough. You may need not just a sports physio, but one with experience of climbing injuries. It's your money of course, but I know I'd rather go for a specialist.

[Simon S]

Sorry to add any extra info into the melting pot, but regarding physiotherapists its sometimes worth paying top whack for the best advice. I once coughed up £85 to see a physio and it was the best money I've ever spent. Mainly because she spotted the problem that I had (arthritus) despite that several other physios, doctors etc had all missed it. I don't wish to be a judgemental, but its very easy to get into the mindset that climbing has caused an injury, as it can often be the case that an underlying problem manifests itself in an injury that appears to be clearly climbing related.
I wish you all the very best, oh and top marks for the disciplined lay off/rehab exercises. I only wish I was so focused.
Cheers

[dobbin]

Dont take this too literally (i.e. dont go and start training like a mutha) but current wisdom seems to suggest against complete rest - to prevent the hard scar tissue build up at the injury site. Nothing hard and certainly nothing that causes any more than dull aches but some movement (easy climbing) can be good rehabilitating an injury.

I've not stopped climbing through my golfers elbow. Could be that mines not been as acute as yours though.

[Paz]

Cheers guys, for starting one of the much more useful recent threads compared to other fora.

normally taut, strong bands of fibrous or connective tissue becoming relaxed and weak

I was under the impression that problems occur because inelastic scar tissue forms, and pain is caused when it tears.  You may need not just a sports physio, but one with experience of climbing injuries.

Scientifically, whilst I'm not going to credit you with being spot on when you are, you sound miles more correct to me, - the mechanics behind that doctor sounds bollocks, were I to view it seriously.  But he or she's not written a complete contradiction, because you have to try quite hard and actually do well defined science to achieve a really good 1=0 contradiction.  They've just written bollocks.  

But for someone somewhere they've been some help presumably, that's what's given them confidence.  But there're probably more doctors and nurses in the UK than serious climbers, let alone ones who can talk mechanics with myself, which is why, like SS says you should see a specialist.  

If you had any other hobby or did any other sport you'd be spending shitloads replacing or repairing worn out kit.  With climbing it's your body, and even though I'd like to scrimp a hundred quid or more and put up with the all my creaks it it'd would be worth it if it sorted me out and I could climb, even I was buying placebos in £land.  You only need a fifty pound set of nuts every twenty years if you look after them.  I know you could get pissed on that but it's twenty years.

But as everyone's already hinted at, the trouble is deciding who to go to first...

[webbo]

i had two injections on my elbow[golfers] my physio suggested it as apparentley golfers does'nt repond that well to physio.however they did'nt help either.i also wore a clamp but again with little respnce.what appears to have worked was doing the exercises in the book pain free.

maybe i should mention i did'nt actually stop climbing whilst under going treatment.although i did have a weekend off.

[LongMonkey]

Going to the docs tomorrow to see if I can get some extra physio, just to make double sure. What book are you talking about webbo?
[what appears to have worked was doing the exercises in the book pain free]

[Lostboy]

My housemate had an injection in his finger after seeing a finger specialist, although he was told it should be a last resort and only works for some people. worked for him though.

[webbo]

Going to the docs tomorrow to see if I can get some extra physio, just to make double sure. What book are you talking about webbo?
[what appears to have worked was doing the exercises in the book pain free]

pain free by peter egoscue.

[LongMonkey]

Thanks webbo. This book has excercises in it for elbow injuries then? Are you elbow injury free now?

[webbo]

i get twinges now and again.i do the maintance exs most days but go back to the exs for whatever body part is giving me gip.i originally got the book to treat my back after a few people recommended it.

[LongMonkey]

Great!  :D  I've found it on Amazon so I'll order a copy. Hopefully it'll do the job.
The doc couldn't really tell me anything more than I already know. He gave his opinion on Cortisone injections but I declined his offer.
Thanks again webbo. I hope this thread helps other climbers in similar situations.

[r-man]

I got that book too. Tried it for a few weeks, but it didn't work for me. Worth a go though - it's a fraction of the cost of one session at the physio...

[7lbs overweight]

Had a couple of cortisone injections for golfers a few years ago.  Didn't make any difference for me, other than hurting like buggery for a while.  

First thing to do with any problem is to get an accurate diagnosis (obviously).  Not just that it's "golfers elbow" but in terms what caused the overload in the first place:  Training error: too much of the same thing?  Progressing too quickly?  Imbalance / weakness / non-ideal movement pattern elsewhere having a knock-on effect and overloading the elbow?  It's certainly worth asking more than one person.  Sometimes this is going to cost money.

Current thinking on treating muscle-tendon injuries is that just resting is not usually the best option once the acute (freshly injured) stage is over, and especially so when the problem has been going on for some time.  Muscle and tendon injuries have been quite well studied, in rats at least, and having some stress on the structure as it heals results in a 'better' scar at the end of the healing process.   Inflammation is 'good' in small doses - it's part of the normal healing process.  When inflammation is chronic (has lasted for more than 3 months or so with nothing special happening to keep it going) it suggests that the healing process has stalled for some reason.   Many suggested tendon injury treatments (Eccentric exercises  http://tinyurl.com/cpfvw prolotherapy, the deep friction massage some Physios. use,) have in common the principle of deliberately 'stirring up' the problem a little in the short-term to try and re-start the acute inflammatory process in the hope that it proceeds through to resolution this time.  

What does this mean for climbers tendon injuries?  The advice to REST COMPLETELY in the acute stage is just as important as ever.  DON'T try and climb though recently acquired pains, this is the surest way to get a long-term problem.  Once you've genuinely rested, had other treatments and things are not getting better, then it's time to try a bit of deliberate stress on the tendon.  An excellent way to do this IMHO is to go out soloing really easy stuff on the grit.  I guess you could do something similar down the wall but it would be incredibly tedious.  A little soreness when you're climbing is acceptable, be guided by how much things hurt the following day.  Build things up slowly and have a summer on the trad. perhaps rather than trying to pull hard too quickly?

Sorry for the long post, none of this is a substitute for seeing someone in person.