[abarro81]

I do mine with a dumbell loaded on one end only. Gripping the threaded bar might not be everyone's cup of tea though!

I do the same. I wear a glove so that the threaded end doesn't hurt my hand.

[r-man]

Got a bit of golfer's elbow bother. Last had this over half a decade ago, and don't feel like having nearly a year off this time. Having read this thread and all of the world wide web, it seems like there is a lot of new knowledge/opinion on the subject, though still no super convincing evidence (correct me if I'm wrong).

Started Bart's eccentric exercises, Tommy's yoga stretchs, and Laurent's dictionary pushups (see billbow's comments here). Will get hold of some weights and do the Athlon eccentrics too.

Anyone know much about ice baths/ice massages? There seems to be a lot of conflicting opinion on these. Ice is good/pointless / ice baths should be only 10 sec/should be 20 min...

Here are two ideas I decided not to try...

After about two years of pain, I decided that no way it was still hurting, and proceeded to use the lopsided weight method to put the range of motion into the pain zone.... after maybe 1500 constant movements, without stopping, the pain receptor or whatever pussy ass thing in there was hurt just stopped hurting. Burnt it out.... my elbow has never hurt again. The cure was over 20 years ago now.

This was good too. What have tendons got to do with the immune system?

I also learned that when your liver is weak, for whatever reason, your immune system will often let the tendons go fist…not a vital part of the body. So a liver detox, or anything to boost immunity is good.

 

[andy_e]

Get Ben Goldacre all over that comment.

[r-man]

Yes, though to be fair, even the more conventional therapies seem to lack solid proof. Again, I'm not a scientist, and if anyone can prove me wrong...

[mrjonathanr]

This was good too. What have tendons got to do with the immune system?

I also learned that when your liver is weak, for whatever reason, your immune system will often let the tendons go fist…not a vital part of the body. So a liver detox, or anything to boost immunity is good.

Bizarrely I've heard a few times that tendon injuries are more common when there is tooth decay. I wouldn't entirely dismiss it out of hand though I couldn't give any supporting evidence.

[abarro81]

From my recent/ongoing experience it's worth seeing a physio to get them to:
1) eliminate 'other' stuff as a cause e.g. back/shoulder issues
2) identify whether the problem is the 'normal' golfers (FCU?) or the pronator teres one (http://www.athlon.com.au/articles/r&i_dodgyelbow.pdf)

Answering (2) will tell you which of the eccentrics is the one for you (normal curls or the sideways twisty ones). I hadn't realised until I saw the physio that doing both of the types of eccentric is supposedly way less effective than just doing the right one for you. I've had much better improvement since I started just using the normal eccentrics following the physio diagnosing that I didn't have the pronator teres version (I had thought that was my issue).

[JJP]

Thats sounds pretty sensible - I used both techniques when I had a problem a few years ago and it did work but quite slowly - out of interest how did they work out which was your primary problem?

[abarro81]

He did a bunch of tests with me resisting a force to see which ones hurt. I was getting slow improvement using both types, but it's definitely speeded up since just doing the one.

[duncan]

Anyone know much about ice baths/ice massages? There seems to be a lot of conflicting opinion on these. Ice is good/pointless / ice baths should be only 10 sec/should be 20 min...

This has been lying around my hard drive for a while.

There are two, seemingly contradictory, reasons for using cold therapy, hence some of the confusion.

In the early stage, especially where there is an identifiable injury with redness and warmth, the aim is damage-limitation: minimise internal bleeding at the injury site. Cold is a short-term local vaso-constrictor, it causes the blood vessels of the cooled area to narrow.  This is a protective response to stop folk getting hypothermia.  So for 2-3 days after an injury, apply cold for 5-10 minutes. The area should feel cold and look white, stop before it starts to go pink.  Let the part slowly return to room temperature (might take a couple of hours) and repeat as often as you like.  Icing should be part of the standard acute injury protocol of  PRICE: Protect, (relative) Rest, Compress and Elevate, all aiming to minimise further damage.  Don’t use heat at this stage. All this is reasonably evidence-based and uncontroversial.

Things get a bit more complicated and controversial in the later stages of injury.  After about 48 hours an acute injury will have stabilised and, conventionally, the aim now is to increase blood-flow to the area to speed-up healing.  Cold therapy is one of many ways to do this.  The initial response to cold is vasoconstriction but, once the body senses only a small area is cold and core temperature is not threatened, vasodilation occurs in most people.  This is the Lewis reaction and usually happend after 5-10 minutes in fingers, sometimes longer in elbows and shoulders.  The response varies between individuals, Lewis’ reaction doesn’t happen in everyone, possibly why some people prefer heat to cold.  People acclimatise: my elbows are now so used to ice that I go to vasodilation almost immediately.  So cold should be applied until the part goes pink and feels warm again, more than 10 minutes usually, and left in place for  - how long? 15? 30? minutes - I don’t know. 

Other ways of increasing local circulation are warmth or moderate exercise and all can be used once the injury has stabilised.  Hot and cold contrast baths for example.

Cold is a good pain-reliever.  This is probably mostly a neurophysiological effect: cold slows nerve conduction and [speculation] may change central (brain and spinal cord) pain perception.  Most long-term pain is associated with considerable modification of central pain processing: pain thresholds become lower amongst many effects.  These modifications occur partially as a result of pain itself so it is theraputic to minimise pain in the early days of an injury and [speculation] good early pain control may reduce the likelihood of developing a long-term problem.   The habit of applying ice to an old injury immediately after exercise to minimise soreness, which certainly works for me, is [more speculation] probably also a mainly neurophysiological effect.

There are various ways of applying cold.  Icy water seems to have the best effect but is a bit hard to carry to the crag. Crushed ice-cubes or ice-chips from an ice-making machine feel much colder than a chemical  ice pack or frozen peas.  I sometimes carry a thermos of ice when I’m getting back into climbing after a tweak. 

[r-man]

Thanks Duncan!

I've never really managed to get the Lewis effect working. Arm goes pink, but that fuzzy warm feeling that other people describe doesn't seem to happen.

[mrjonathanr]

Your water could be a bit too cold.

[duncan]

I've never really managed to get the Lewis effect working. Arm goes pink, but that fuzzy warm feeling that other people describe doesn't seem to happen.

I don't think what you feel is crucial.  Descriptions people give to bodily sensations are - obviously - subjective and highly variable. If your arm is going pink then vasodilation is occurring which is what you are aiming for.

[SamT]

What about Deep heat/ralgex.  Does this not do the same thing i.e vasodilation.  (my skin certainly goes pink).

[r-man]

I've never really managed to get the Lewis effect working. Arm goes pink, but that fuzzy warm feeling that other people describe doesn't seem to happen.

I don't think what you feel is crucial.  Descriptions people give to bodily sensations are - obviously - subjective and highly variable. If your arm is going pink then vasodilation is occurring which is what you are aiming for.

That makes sense. I've previously been a bit put off by the fact that everyone describing the Lewis effect says your arm should feel warm. Perhaps this is a mistaken assumption that hasn't been examined properly?

Another thing I was wondering about. When doing all these elbow exercises, at what point are the tendons supposed to do the actual repairing? Between exercises, overnight, or do you take a day off every now and then? I'm assuming that like muscles, tendons need some down time to get stronger, but perhaps this is incorrect?

[Ti_pin_man]

Over the last 6 onths I've decided to really try and improve my beginner skills and get climbing 3 times a week at least, its been great BUT over the last few weeks I've gotten some soreness on the inside of my elbow... as the pain didnt get better, but didnt stop me climbing I researched on the net and began to be a bit worried it might be climbers elbow.

The reason for posting is that last night I finally went to see a physio and she pull and twisted, prodded and poked, listening to my history of injuries and the conclusion is that its just soreness on the muscle from increased use!  So all I am say its defo worth popping to see a physio before assuming you know what the injury is.  Glad I did!  Hooray!   

[ERU]

This is a REALLY good source of info:
https://www.facebook.com/groups/WinterClimbsinSouthWales/585869764761238/

Also some honest feedback on using a 'Armaid'

[tomtom]

This is a REALLY good source of info:
https://www.facebook.com/groups/WinterClimbsinSouthWales/585869764761238/

Also some honest feedback on using a 'Armaid'

Its a closed group. Fancy copy and pasting the right bit up here?

[mrjonathanr]

Wanted to resurrect this thread like lazarus, as my right elbow has risen up from happy peace to torment me. I'd say inexplicably, but adding campussing on small rungs to plenty of bouldering may not have been the smart move I thought it was at the time.

So I've got medial epicondylitis and a bunch of exercises to do due to shoulder imbalance.

Main question re eccentrics:

how did people who've been through this decide to go for extension or pronation exercises.

thinking of getting one of these  theraband flexbar thingies:
http://www.amazon.co.uk/gp/product/B000KGOMDK/ref=olp_product_details?ie=UTF8&me=&seller=

only which would be better, heavy (blue) or medium (green)?

Any help/ideas very gratefully received!

Thanks

Jon

[abarro81]

how did people who've been through this decide to go for extension or pronation exercises.

I went to the physio.. you could try doing both (as I did initially) but apparently it works better if you just the the one relevant to your main issue (and, in my experience, it has indeed worked better).

[mrjonathanr]

Thanks for your reply Alex.

I went to the physio last night but he didn't advise one vs the other, just said extension for FCU more likely to help than pronation for PTeres so see how you go with that and total rest and come back in a week.
I'd have gone to see Jon at clinic 919 but am in Stockport so went to see a specialist for golf injuries in Altrincham.
Quite interested in the flexbar as Serpico recommended it to me a while back.

Can I ask which physio you saw and how you fixed it?
Did you continue to climb and how long did it take?

Thanks again.
Jon

[highrepute]

Thanks for your reply Alex.

I went to the physio last night but he didn't advise one vs the other, just said extension for FCU more likely to help than pronation for PTeres so see how you go with that and total rest and come back in a week.
I'd have gone to see Jon at clinic 919 but am in Stockport so went to see a specialist for golf injuries in Altrincham.
Quite interested in the flexbar as Serpico recommended it to me a while back.

Can I ask which physio you saw and how you fixed it?
Did you continue to climb and how long did it take?

Thanks again.
Jon

Hi Jon,

I've got a blue flexi bar. I find it really good for the old golfers (i do the equivalent to the extension exercise). . I showed it to Alex and he preferred just to use weights.

I had golfers really bad a few years ago and saw Jon at the 919, his advice would very much follow this article www.athlon.com.au/articles/r&i_dodgyelbow.pdf, plus daily icing and some serious massaging in the area and probably also around the neck/shoulder/back as he would suggest tightness here would inhibit recovery in the elbow. Of course tightness here also points to other problems!

I had elbow pain for nearly a year and at times was painful enough to make me cry. Full recovery in under 3 months. I climbed while recovering as long as I experienced no pain. Elbows are as strong as ever now and if I do get a bit of pain the extension exercise sorts me out.

I assumed shoulder instability too so have since worked hard to improve conditioning here, flexibility across back and posture while climbing.

I believe that 3 finger dragging causes my golfers as doing a lot of this seems to aggravate.

There is hope! Good luck

James

[mrjonathanr]

Hi James thanks for your considered reply.

Looks like the blue flexbar thing is the one to try.

I'm familiar with the the advice from the 919 Clinic and Saunders dodgy elbows.  The picture I'm getting seems consistent - rest, self-discipline, eccentrics, massage, ice and stretches seem to be the industry standard for this problem.

The physio recommended a masseuse - she works with the GB athletic team - I went today and my elbow doesn't feel tight tonight. This may be because my general soreness and sensation of being abused  have distracted me from my elbow woes. Or maybe back, shoulders and forearms were all way too tight. Time to take up yoga again I think.

Might give Tom Randall's stretches a go too.  http://tomrandallclimbing.wordpress.com/2012/11/23/golfers-elbow-a-possible-solution/


These shoulder stretches seem worth a try too: 

I'll report back for those interested in this complaint.

cheers

Jon

Thanks for the encouragement.

PS 3 finger drag - wouldn't that really stress ring-finger flexor ie FCU? Makes sense to my rudimentary understanding.

[Boredboy]

Hey, I've got a golfers elbow at the moment due to fingerboard use 

Because its still quite acute I use ultrasound, strapping, stretching and acupuncture which helps loads and I can still climb / train without to much bother as long as I avoid locking of on the fingerboard.

If it's been hanging around for a while and the tissue has become in a chronic state then the eccentric stuff and local massage / stretching is definitely the way forward.

I went to an interesting lecture given by a leading expert in electrotherapy and tissue repair on the stages of healing in tendinopathy. They looked at the tissue from various people having surgery for golfers / tennis elbow. He thought that each individual case is different and to get the treatment right you have to judge what stage of tendinopathy / inflammation or dis-repair the tissue is in. Unfortunately this means what might make one persons problem better may aggravate or not change another's.

[krymson]

I train lock off regularly on a pullup bar as well as at the wall sean-mccoll style. I am doing campusing as well as fingerboard about once a week and havent really had elbow issues, or when i had them they went away quite quickly

I've been keeping up antagonist training by doing pushups and tricep work, as well as doing preventative elbow maintenance with eccentric wrist curls. Being light also helps a bit

The closest i get to elbow pain is momentary niggles from deep lock off on the lower hand while campusing, but the preventative work i do seems to keep things at bay... knock on wood

[abarro81]

Can I ask which physio you saw and how you fixed it?
Did you continue to climb and how long did it take?

Started last August/Sept, I still have issues with the elbows. I can climb fine, but no campusing and have to limit fingerboarding. Plus no significant volume of downclimbing. I've continued to climb/train the whole time, didn't take any full rest, the most was to ditch all high volume training (aerocap, arc etc) and all fingerboarding for a while. I've done some of the hardest stuff I've ever done recently, so definitely have been able to climb/train through the issues rather than having them be a major setback.
Saw John Ostawhathisface. He said only to do 20 reps per day, but I usually do somewhere in the 20-60 region, after climbing, don't do them on rest days. I think this kind of thing is something you manage, and the standard rehab time is very much measured in months rather than days or weeks.