[dave k]

I have decided to take a 2 week break from bouldering to try to shake off some bicep tendinitis/tendinosis in my right arm. I have had several occurances (say 5) since January although 2 days rest and some ibuprofin is normally enough to clear it up. 2 or more days bouldering in a row tends to be the catalyst for an occurance.

My query is should I ice the inner elbow and take ibuprofin during the 2 weeks? Considering I have not bouldered since Saturday (when I had symtoms) and have few symtoms today (pain/obvious inflammation). Will continuing to use ice and/or ibu hinder or assist the recovery? I will be taking crushed sea creatures and condroitin and massaging too.

If this does not work then I plan to see my GP/a sports physio or accept I have mild tendinitis and just keep climbing over the summer (avoiding strenuos moves) and hope it clear up. I will also back it up with pushup, tricep, shoulder work.

I have read lots of previous threads on this issue both on here and elsewhere,but there seems to be some conflict of opinion on ice and ibuprofin. Dave Macloud uses cold water immersion to encourage blood flow to help speed up recovery from pulli tears. Has anyone tried this rather than ice during the recovery period for bicep T?

All advice gratefully received

p.s. I am aware that complete rest might actually make things worse, but I am going to try a short break and see if it gives the tendons a chance to recover. I will then (try to)build up the training gradually.

[GCW]

You ask a few questions here.
From what you say you have medial epicondylitis (Golfer's Elbow).  There are various treatments for this; icing, massage, anti-inflammatories included.  Rest and stretching arte also factors.

Do you warm up well before bouldering?  And warm down afterwards?  Are there particular moves that annoy your elbow?  (Really deep, powerful locks get me after a while).

The idea of ice/ cold water is to reduce inflammation.  Either should be fine.  Some people argue that cyclical hot/cold works better, as you get cold (anti-inflammatory) and heat (stimulates bloodflow).  Whether this is better than simple cold treatment is debatable.  Ibuprofen is a non-steroidal anti-inflammatory drug (NSAID) and will also help reduce pain and inflammation.  There is some shaky evidence NSAIDs reduce blood flow in healing tissues.

I would have thought cold treatment and ibuprofen would be a reasonable course.  Stretches and local massage will also be of benefit.  Full warm up/ warm downs are also vital.

[webbo]

i read an article recently that reckoned most non steroidal anti inflammatories take 6 to 8 weeks to have an anti inflammatory effect apart from celecoxib/celebrex which works in 6 to 10 days.there was another fast acting one mentioned bextra but that isn't in the b.n.f.

[dave k]

i read an article recently that reckoned most non steroidal anti inflammatories take 6 to 8 weeks to have an anti inflammatory effect apart from celecoxib/celebrex which works in 6 to 10 days.there was another fast acting one mentioned bextra but that isn't in the b.n.f.

I read the same article and it seemed authoratative. I can`t however find support for this view anywhere. He claims that ibuprofin takes up to 8 weeks to have any anti inflammation effect, so most people have recovered before they get this effect. Therefore ibuprofin just has an analgesic (pain relief) effect in the short term.

 

[webbo]

Gareth should know hes a quack.my thoughts from that article is that nsaid's are more for chronic conditions such as arthritis.

[dave k]

I don`t think I have golfers elbow as the pain originates in the tendon/area above the elbow (jnside) on the lower end of the bicep. I think it a form of bicep tendinitis. Most bicep tendinitis occurs in the bicep tendon where it joins the shoulder, but it is possible to get the same at the lower end of the same tendon. Most research on bicep tendinitis tends to only give treatments for this upper shoulder area, with stretches and shoulder strenghtening exercises.

There is little correlation between type of move and pain. Although pulling onto the the side pull on that problem left of the press has caused it twice.

Thanks for the advise- I will continue to take ibuprofin for a the next week of so and use cold treatment and massage. Once I start bouldering again I should definitely also do more structured warm ups and cool downs.

Recently I have been taking ibuprofin before going bouldering, which is a bad habit to get into!

I do find supporting the tendon above the elbow with wide tape seems to stop the symptoms occuring. But again I don`t want to have to use this on a regular basis in the future.

 

[jfw]

for site specific injury thats easy to reach - i recommend trying ibuprofen gel  (if you are taking ibuprofen regularly - you are not doing your stomach lining any favours)

ibuprofen acts as a prosta-glandin inhibitor - some prostaglandins can cause inflammation (bad)

some prostaglandins also help you produce the mucus in your stomach that stops you digesting yourself (good)

(othe prostaglandins help enzyme lung function (good) - so ibuprofen can cause bronchoconstriction in some asmthmatics)

when you take ibuprofen (and some other non steroidal anti inflammatories) you can inhibit production of both(all) types of prosta glandin.

if you find the pills most effective you can minimise risk to stomach by taking them with food (or milk) - also try to avoid taking them just before going to bed.

ibuprofen gel acts in the same way - but tends to act more locally - it gets absorbed through the skin and can still have some of the system side effects shown above if you use shed loads - but generally you reduce the risk of side effects.

[fatdoc]

plasma levels using gels are variable from 0 to same as oral intake.

but, i agree - success with nsai gels on elbows is common.

the time for the nsai to work is debatable on you end point. I've not read that paper. If it was in chronic arthritis inflammatory markers forget it for acute pain, not relevant.

I agree, the evidence for nsai causing delayed healing, esp in soft tissues is more than a bit thin.

This injury is too longstanding to be a simple *tweek*

You need to see a good physio / therapist soon.



Dont leave it a moment longer.

[The Sausage]

Although you may be right in your diagnosis of tendonitis, there are other things it could be, such as nerve irritation. On top of that, the root of the problem may not just be that you're not warming up properly and not allowing it to heal fully before starting to climb again.

I think that many elbow problems are postural in nature, for 2 reasons:

1. If you have the classic climbers posture of rounded shoulders and inwardly rotated arms (i.e. palms facing backwards-ish in standing), your arms will hang with a slight bend at the elbow. This means that the bicep and the flexor muscles of the forearm will probably only be straight when you are climbing. So they'll become shorter. The 2 things that put tension into a muscle/tendon are (obviously) load and stretch, so not only are you loading your muscles/tendons, you're also stretching them as well. At the same time.

2. The position of the neck can cause irritation of the nerve as it exits from between the vertebral bodies; poor shoulder position and stability can cause impingement of nerve and tendon, causing referred pain down the arm. An irritated nerve is far more susceptible to injury at other points along its length.

Really, you ought to see someone who knows what they're talking about. But finding that person is difficult. There aren't many climber specific physios out there, because there isn't any money in the national competition teams for that to happen. I think climbing injuries are difficult for an 'ordinary' physio tp get to grips with: they'll be trying to fit it into their own frame of reference, when the demands of our 'sport' (and therefore the injuries that go with it) are unique.

If you feel you do stand as i described, you could try some pilates style exercises - stand up tall from the pelvis, tuck your chin in and let the curve of your upper back straighten a bit (don't just pull your shoulders back). You should feel your upper arms turning out and your elbows straightening.

It may not help, but it's better for you anyway.

[fatdoc]

very sound advice from the sausage.


If you're in sheffield you get my usual recomendation of the attention of Paul Wilson at the sheffield chiropracter clinic in woodseats.

It's gonna hurt a bit mind...

[dave k]

Good advice. Thanks for your time.

I certainly don`t have a great or even good posture, however I do utilise a number of exercises that I have picked up from 6 months seeing a chiropracter for lower back issues, as well as pilates classes I went to a few years ago.  I always do theses exercises religiously for 10 minutes in the morning and 10 in the evening. Undoubtedly I should commit more time to them, and make then more focused on developing a good posture, rather than building up my core lower back muscles. Having said that I have been doing these exercises for years and so must be in better shape than the average climber.

Having looked back at my training/injury record on 8a.nu I am hoping I may have over reacted. I had one dose of tendinitis at the start of Feb in my left arm. Then had my best and most sustained period of bouldering (with no tendinitis) till visiting Bleau in early May (where I had it in both arms).Since then only my right arm has been an issue , so I am hoping that I have not given it time to recover.