[Fiend]

I don't even play fucking golf...

Okay here's the deal:

History:
No previous injuries of this nature. Mid-February I pulled hard on something down The Works and felt a shock go all the way up my inner left arm. Didn't feel sore, just like a twang. Massaged it and tentatively tried climbing on it - felt fine. Kept up with a normal climbing schedule but after a few weeks it started to hurt more, particularly after and sometimes during bouldering. I eased off on indoor climbing but still did outdoor stuff, albeit with more care. The injury persisted, but was most noticable on certain types of pulling hard moves - fairly steady climbing didn't affect it much. It was also noticable in some random non-climbing situations, including waking up with it feeling tweaked (sleeping on it funny?). I've given up on sport, bouldering, and indoors, and am sticking to relatively physically easy trad outdoors, as well as various recuperative treatments.

The injury:

The main site of pain is the small elipse above, exactly where the tendon from the forearm muscle meets the boney spur inside my elbow. This does not hurt at rest but is slightly painful to the touch at rest. It is slightly painful to clench my thumb and little finger together, less for thumb and 3rd finger. After easy trad climbing that area usually feels a bit more painful (noticable but not very painful) and the larger elipse sometimes has some mild pain in it. IF I've done something more intense climbing (which I avoid these days), OR random non-climbing stuff that hurts it, it will be more painful - not excruciating but sometimes enough to notice at rest - for about a day.

Current treatment:
I've been to see Ozzy a few times. He has massaged it brutally which tends to be sore afterwards but once that soreness fades the actually injury has felt better. He has been happier with the strength tests on pinching etc in the latest session.
The home treatments I am doing:
Iced water bath 2 x 30 minutes daily - this has seemed to help, it certainly feels better when I do this regularly.
Massage 2 x 10 minutes daily, focusing both on the specific site and the area around it, as hard as I can - this also seems to help, sometimes I can feel the pain easing during massage.
Massage 5-10 minutes before climbing.
2 x 20 press-ups not as often as I should.
Ibuprofen regularly when climbing.

Climbing:
Only going away on trad climbing trips, particularly where there's plenty of choice of mid-grade trad so I don't have to pull too hard.
Avoiding physically difficult climbing in favour of more adventurous climbing
Climbing at up to roughly 50% of my physical limit.
In between trips, resting elbow entirely apart from very light active rest and the above recuperative treatments.
Basically keeping doing some climbing, but much gentler stuff, spread out, with plenty of rest in between.

Thoughts?? Advice?? My general plan is trying to balance out giving my elbow a chance to heal with not completely wasting the summer with months of rest. Let's face it if I rest completely for two months now it's going to cunt it down in August and September isn't it...

[fatdoc]

superb synopsis of an injury there Fiend.

If you've seen Ozzy and there are not major muscle tears etc... (which there wont be, coz he'll have checked)

then I can only advise

- get one of those £100 ultrasounds from Boots etc.... really damn good in combo with all your doing, 10 mins once a day MAX (best every other, then do hot /cold on it)

- some acupunture, how's your neck / back? bet it's not right after months of climbing *weak* on one side. Has ozzy *done your shoulders / neck?*

- see someone else? Dont get me wrong Ozzy is top.... you might need a more whole arm & shoulder & neck massage / freeing up (read hideous screaming)... Paul wilson at sheffield chiro clinic is the man for this. I see both Paul and ozzy, I recommend both...


oh, and dont worry about the golf... it's common in climbers!

[Fiend]

Cheers fatty...

Ultrasound breaks down scar tissue and reduces inflammation, right?? Would it be significantly more effective than massage at this stage??

Ozzy actually did a bit of shoulder stuff in a previous session, and in a recent session he had a play around and reckoned there wasn't much of a problem there.

I could try Paul @ SCC too. What's his number??

[i.munro]

I'm sure you know this but a physio told me to do the negative (eccentric?)only half of reverse wrist curls  (palm down)

[Ru]

www.athlon.com.au/articles/r&i_dodgyelbow.pdf

Download this, read it, do what it says. I had this for getting on two years and tried everything. Accupuncture, stretching, physio, rest (although to be fair I never actually rested it for long), ignoring it and hoping it would go away, etc etc. Then I read this, did what it said and it went in about 3 days. If I feel it coming back I start the exercises again and it goes again.

Now this might be a complete coincidence, but it might not be.

Good luck.

[fatdoc]

Cheers fatty...

Ultrasound breaks down scar tissue and reduces inflammation, right?? Would it be significantly more effective than massage at this stage??

Ozzy actually did a bit of shoulder stuff in a previous session, and in a recent session he had a play around and reckoned there wasn't much of a problem there.

I could try Paul @ SCC too. What's his number??

789 Chesterfield Road
Sheffield, South Yorkshire, S8 0SP
0114 274 5656

oh, and try Ru and Ian's ideas...

[Fiend]

Although, Ru's and Ian's exercises are the opposite way around i.e. Ru's palm up, Ian's palm down. I think Ru's are the right ones.

Dumbells dumbells....where are you...?

[i.munro]

Although, Ru's and Ian's exercises are the opposite way around i.e. Ru's palm up, Ian's palm down. I think Ru's are the right ones.

Depends on the problem I suspect. I had pain on the inside of the elbow but the physio got me to do the palm down ones & it worked.

I guess that's why they do all that training.

[webbo]

if you read the article that ru posted,it says that you are more likely to need the palm down exs as a result mouse injuries rather than climbing induced golfers elbow.

[Three Nine]

could someone please talk me through the BR stretch in the diagram in the article in Ru's post. I don't quite understand it?

[webbo]

as i understand it.sit down,put your right arm along side your right leg with the back of your hand facing your leg,little finger facing forward.inter lock the fingers of your other hand and twist in an anti clockwise direction keeping your arms straight and hold for 25 secs.do the same on the otherside but turn in a clockwise direction.

[cider nut]

fatdoc

> then do hot /cold on it
The cold treatment that Fiend mentions is meant to be better than this, same effect but gets to deeper tissues.

i.munro

> I'm sure you know this but a physio told me to do the negative (eccentric?)only half of reverse wrist curls  (palm down)
Agreed.  Golfer's elbow is in the wrist flexor, so strengthening the wrist extensor helps to solve any muscle impbalance that may be the cause of the problem (hope I've got flexor and extensor the right way round).

[runt]

Fiend, some of your description sounds a bit like an injury I had, which after all sorts of problems and different doctors and physios turned out to be nerve damage in my forearm. (caused after weighted pulls gone wrong and a twang sensation) Have you had this checked out? do you still get pain or any numbness in your hand or fingers? good luck with it

[cider nut]

Regarding palm down and palm up - the pdf isn't saying to do palm up wrist curls, it's talking about eccentric contractions, which are different, as you only lower the weight, not lift it. 

Eccentric contractions help strengthen the affected tendon (as explained in the text, as this particular exercise doesn't strengthen the muscle much).  Whereas reverse wrist curls (palm down) help strengthen the antagonistic (opposing) muscle so avoid/fix muscle inbalances.  I reckon both are important.

[Fiend]

That's a useful way of clarifying it, Ms Nut - ta.

[webbo]

the only problem with the palm up exs is the dumbell bar catchs on those little lumps from my dupuytrens thingy.

[duncan]

…this is from a lot of fingery/crimpy/pockety/slotty stuff, rather than lush Font slopers or whatever…

Injury often has a lot to do with technique, and elbows are no exception. There are marked biomechanical differences in how the forearm muscles respond when crimping. The load on the (muscle usually implicated in golfers elbow) when you are crimping is far greater than when slapping up slopers.

Two groups of people crimp: beginners—because it feels stronger—and those who never grew out of it.

Two groups of people crimp significantly less: those who naturally evolved, and those who injured themselves crimping.

Besides reducing the propensity for injury, climbing open-handed will automatically give you greater endurance (that’s another article on its own). Thus the benefit to your climbing career will be twofold.

Two different problems with the same solution?

[duncan]

Wrist curls: palm down or palm up?

As ms. Nut says, the idea of palm-up negatives/eccentric (controlled lowering) exercises is that they stress the flexor tendon and stimulate healing. There us some evidence that this works for Achilles tendon injuries, but I’m not sure if people really know why.

The idea behind palms-down (lifting) is that you are correcting a muscle imbalance by strengthening the wrist extensors. 

So palms-up is treatment, palms-down is prevention. 

[wild speculation] However, when you do palms-down curls you are also working the finger flexors (by gripping the bar) and these are lengthening - working eccentrically - as you lift the bar.  This might mean palms-up curls are a two for the price of one exercise.

[cider nut]

Duncan - is there a typo in the last bit, up instead of down or vice versa?

[duncan]

Arrrrg! Thank you.  It is probably nonsense anyhow, but to clarify:


[wild speculation] However, when you do palms-down curls you are also working the finger flexors (by gripping the bar) and these are lengthening - working eccentrically - as you lift the bar.  This might mean palms-down curls are a two for the price of one exercise.

[i.munro]

Arrrrg! Thank you.  It is probably nonsense anyhow, but to clarify:


[wild speculation] However, when you do palms-down curls you are also working the finger flexors (by gripping the bar) and these are lengthening - working eccentrically - as you lift the bar.  This might mean palms-down curls are a two for the price of one exercise.

Seems to me that this (changing the length of the finger flexors while they are under tension) is close to the action of climbing where the angle of the wrist changes as you move past a hold??

[Fiend]

Interesting comment by an unknown person on the font of all medical / climbing injury knowledge:

http://www.ukclimbing.com/forums/t.php?t=307808&v=1

The bad news is that you MUST stop climbing for between 12 - 18 months.

Anyone like to confirm or deny whether that is true??

[webbo]

when i've had golfers elbow in the past and was told to wear a brace and not climb for 3 months.i just wore the brace,did various exercises and generally carried on as normal and it stopped hurting after a few months.

[cider nut]

Deny, according to this:

http://onlineclimbingcoach.blogspot.com/2007/04/layoff-vs-slow-return-to-activity.html

Although I'd be wary of taking the timings too literally - I expect three weeks is if you stop immediately on being injured, rather than stopping after months of climbing on an injury and aggravating it

[webbo]

if you speak to enough people,read enough articles,listen to enough experts.you will eventually hear what you want to hear.which is that its ok to carry on climbing,training ,wanking etc.