UKBouldering.com
the shizzle => diet, training and injuries => Topic started by: Fiend on June 09, 2008, 01:14:20 pm
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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:
(http://www.fiendy.pwp.blueyonder.co.uk/elbow.jpg)
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...
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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!
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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??
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I'm sure you know this but a physio told me to do the negative (eccentric?)only half of reverse wrist curls (palm down)
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www.athlon.com.au/articles/r&i_dodgyelbow.pdf (http://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.
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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...
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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...?
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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.
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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.
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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?
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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.
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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).
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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
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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.
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That's a useful way of clarifying it, Ms Nut - ta.
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the only problem with the palm up exs is the dumbell bar catchs on those little lumps from my dupuytrens thingy.
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…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?
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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.
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Duncan - is there a typo in the last bit, up instead of down or vice versa?
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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.
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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??
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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??
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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.
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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
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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.
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Very true. But it you speak to enough people,read enough articles,listen to enough experts, you can eventually come to an informed opinion on what's best to do and what works best for you :)
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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.
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.
QED!
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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??
In general, 12-18 months complete rest for tendon problems is now an unusual view. That poster's suggestions regarding NSAIDs are also about 15 years behind current knowledge and best practice. Tendon problems of a few months standing have little or no inflammation, so anti-inflammatory drugs have little or no role in their management.
Speaking generally again, people tend to under-rest when problems are recent but over-rest when they have been going on for some time.
It is inappropriate to give very specific advice over the 'net, even when (as you have fiend) the problem is described very clearly.
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duncan, are you a physio? If so where are you based?
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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??
As said before, I didn't stop climbing at all. While I was trying to find a cure I needed to take days off to let the pain subside though. Have you read and tried the exercises in that pdf I linked to?
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Yeah, going to pick up some weights of a friend this week.
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I have exactly the same injury as described Fiend. Reading the article suggests it to be tendonosis. It goes when I warm up and hurts when I do actions like washing my face.
If I try the exercises though, it makes my wrist hurt and almost kind of click, is this normal or just a result of the injury, or am I using too much weight. If I use less weight, then it doesn't tire the arm, so I could do millions of reps.
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I've started the exercises, on 10-12kg, about in the middle of the range suggested. Like yourself it makes my wrist ache a bit and occasionally click, it feels like a lot of strain is going through it. I do get a bit fatigued in the arm as required but not a lot.
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The bad news is that you MUST stop climbing for between 12 - 18 months.
no absolutes in medicine. i think he's talking shit. i had tendonitis, it was fucking rubbish, generally related to my my posture and campusing. i stopped doing this and stood up straight, had a lay off of 3 weeks and went swimming, running and did heaps of press ups.
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I've adapted the wrist curls thing with a theraband, and it gives my wrist aload less gip. I sit down and stand on the ends of the band and lay my forearm along my thigh, and then stretch the band upwards. No wrist pain this way, and more arm fatigue.
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New suggestion from my physio, in case anyone is interested, is to wrap something (towel or I'm trying handlebar tape) around the dumbbell to make a fat grip when doing the eccentric half of wrist curls so that the fingers are gripping as when climbing.
Also what do the commitee think about doing one arm/hand training with the good arm(after two weeks out I'm getting a bit twitchy).
I suspect this is jsust a good way to get matching injuries?
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I had a similar injury from doing too many thuggy overhangs (same place but on the tricep tendon). I didn't stop climbing i just did loads of slabby technical routes till it went away, the sort of stuff where the holds are too poor to crank on. the added bonus is that my footwork is pretty good now. I took ibuprofen whilst i was climbing but i think it did more harm than good, it wouldn't hurt when I climbed but I really felt it the next day! So basically, try and climb like a girl.
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Ok I'm doing the palms up eccentric stuff as advised by my physio & discussed on here but it only felt uncomfortable for the first day or so.
If it doesn't hurt the injury (even a ickle bit) does that mean I'm trying to strengthen the wrong bit?
Getting really frustrated now!!
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New suggestion from my physio, in case anyone is interested, is to wrap something (towel or I'm trying handlebar tape) around the dumbbell to make a fat grip when doing the eccentric half of wrist curls so that the fingers are gripping as when climbing.
Also what do the commitee think about doing one arm/hand training with the good arm(after two weeks out I'm getting a bit twitchy).
I suspect this is jsust a good way to get matching injuries?
Supposedly Gresham was once found working out with one arm whilst the other was broken or something, people scoffed at this until he produced some book or paper or something on neuromuscular symmetry however i'm not sure if its actually a load of tripe after watching lady in the water.
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I'm afraid you lost me with 'Lady in the water' ???
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Booked to see Ozzy at the end of this week and Paul @ SCC after the weekend. Will see what they have to say about exercises and stuff.
I'm wondering with this eccentric business, whether light climbing training and then downclimbing everything you go up could be useful for tendon-strengthening on the same basis??
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I'm afraid you lost me with 'Lady in the water' ???
Its a film and it has a guy in it who only works out one side of his body, needless to say one side of his is bigger than the other. Shit film.
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Its a film and it has a guy in it who only works out one side of his body, needless to say one side of his is bigger than the other. Shit film.
Ah ok thanks (shouldn't it be called crabman returns or something?). I seem to remember reading somewhere that training the uninjured side is a way of reducing atrophy in the injured limb but I've no idea if or how this applies to sports performance.
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Booked to see Ozzy at the end of this week and Paul @ SCC after the weekend. Will see what they have to say about exercises and stuff.
So what's the word?? I'm just about pain-free now & wondering where to go from here.
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Ozzy dealt with it pretty much as before. He confirmed the excercises had good reasoning behind them and that I should keep doing them. He also suggested a way of taping directly around the elbow and said that after 6 weeks pretty much total rest, more rest would be counter-productive - gentle climbing and continuing with the exercises would be good.
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Ozzy dealt with it pretty much as before. He confirmed the excercises had good reasoning behind them and that I should keep doing them. He also suggested a way of taping directly around the elbow and said that after 6 weeks pretty much total rest, more rest would be counter-productive - gentle climbing and continuing with the exercises would be good.
Thanks. Looks like we're at almost exactly the same stage. Guess I've been lucky as I first posted to this thread before current problems started.
Were you given any thoughts on how/when to combine gentle climbing & rehab? How many time a week rest days etc?
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No, I'm not at the pain-free stage. Have mild pain upon pressure at any time, and more noticable pain after any climbing / similar usage.
I wasn't given any specific advice on rehab. Just keep doing massage, ice water, dumbell exercises, and light climbing, and don't go anywhere near my physical limit.
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Thanks again.
I'm trying to work out whether to do the dumbell stuff on the same day as gentle climbing or not & how much I need to rest. Back to the physio I guess.
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- 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...
Well it wasn't quite that bad as he worked on my forearm only. But it was plenty painful enough. He scared me at first. I don't like military people - they are trained killers. And I'm not.
Anyway he did a lot of friction massage and loosening stuff around the muscle and tendon. Says this is very important (I had mostly been massaging the tendon area). Muscle feels noticably softer afterwards.
Recommended to keep doing the eccentric dumbell exercises (and the antangonistic muscles), keep doing the ice water and my own massage. Recommended a specific strap around the elbow during exercise that puts pressure on the tendon before the injury site to give it more chance to heal.. Recommended as much rest as possible but if I am doing anything that puts strain on it, that I must ice it after usage.
Errr so there we go. Still injured. Still pissed off.
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Been suffering with this myself for around the last 6 weeks! Just found this article by the same guy that wrote the "Dodgy Elbows" article in Rock & Ice. It gives some further recovery adivice that may be of interest!
http://www.athlon.com.au/articles/sportslink_pg6-9.pdf (http://www.athlon.com.au/articles/sportslink_pg6-9.pdf)
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Just found this article by the same guy that wrote the "Dodgy Elbows" article in Rock & Ice.
Thanks for that. Any & all info welcome.
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Quick question: Eccentric exercises, should I do low weights / high reps, medium / medium, or high weights low reps? At the moment doing 3 sets x 10 reps x 14kg daily, or the same with 16kg if I go to the gym. I can feel a very slight stress on the injury (right arm, different injury this year) but overall this feels pretty comfortable... :weakbench:
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Assuming a common flexor tendonosis and not one of the other reasons for medial elbow pain, the general view is to keep the reps. fairly low and gradually increase the force through the tendon. You can increase the force by increasing the weight or increasing the rate of deceleration. If you are getting elbow pain after dynoing/snatching then making the deceleration phase of the roll short and sharp might be an idea.
You could also try a more climbing-related finger flexor eccentric exercise by holding a half-crimp position and lowering yourself into an open-handed grip. Probably best if you start this is partially loaded not full body-weight - stand on scales. This would have the usual advantages and disadvantages of more specific exercises: more likely to carry-over to the real thing, harder to quantify, easier to do wrongly and possibly riskier. Usual caveats about random advice apply.
Discomfort at the painful spot whist exercising is certainly acceptable and probably desirable. If you get a constant ache the following day you need to ease-back slightly.
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Just read the Athlon dodgy elbow article and started following it religiously, it does say that the exercises will aggregate the injury. But they also aggregate The brachoradialis. Is this normal? Should i see a physio to check I am doing them right. Keep getting the feeling I'll make it all worse some how! Cheers
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Also I just reread some of the posts and people suggest push ups. I thought this would be counter productive...
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Do the Dodgy Elbows exercises 3 sets of 10 for both eccentric wrist curl and the hammer exercises. The ten reps should be at a weight that is tiring but not causing failure. Two days on, one off, or every other days works. The very important detail is to consistently play with the angle of your elbow while doing the exercises and to do them at the angle which is most irritating to the injury - aggravation during the exercise is a good thing. I know of people who have done the exercises for two months with no benefit and then went from injured elbow to fine elbow within 3 weeks of doing the hammer exercises with an almost completely straight arm. You could ice in a bowl of water and ice cubes for 10 minutes after your exercises for a few weeks, this will help settle any inflammation issues that you may currently have along with the epicondylosis.
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all about elbow angle then. cheers
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Whats the hammer exercise..? (awaits torrent of abuse...)
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in the 'dodgy elbow' article its the exercise where you have weight on one end of a dumbell bar... i think...
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in the 'dodgy elbow' article its the exercise where you have weight on one end of a dumbell bar... i think...
Is that a twist exercise? Like the wrist curls but instead you rotate the wrist..
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Yeah not the wrist curls the other one where you resist the weight as it pulls you're palm to face up. Just realising how hard it is to describe it haha
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I have heard that over using ultra sound can start to brake down bone structures :jaw:
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Anyone else had pretty major numbness/ pins and needles type symptoms from their Golfer's Elbow?
I'm getting really numb hands overnight and when waking up (sometimes the pins and needles occur at other times e.g certain angles of holding a knife and fork). I've had flare ups of Golfer's before (remedied with the eccentric dumbbell curls) but this one is BAD.
At the moment I'm doing the curls daily and I've added in 2 sets of 20 push ups in the last few days as a desperate measure.
Anyone?
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Anyone else had pretty major numbness/ pins and needles type symptoms from their Golfer's Elbow?
I'm getting really numb hands overnight and when waking up (sometimes the pins and needles occur at other times e.g certain angles of holding a knife and fork). I've had flare ups of Golfer's before (remedied with the eccentric dumbbell curls) but this one is BAD.
At the moment I'm doing the curls daily and I've added in 2 sets of 20 push ups in the last few days as a desperate measure.
Anyone?
Just a thought but there are a few nerves that run through the elbow joint, radial, ulnar etc.. . If you have swelling or a lot of scar tissue on the golfer tendon it may be inpinging the nerve. Best thing to do would be ice and rest it and commence the strengthening when it's back pain free.
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As the previous poster says, doesn't sound like purely a tendon problem, but suggests nerve irritation somewhere. 'Somewhere' could be around the elbow* but it could equally be neck, shoulder or wrist or a combination. You need to see someone to be sure. Usual terms and conditions apply.
*like Jerry
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I was lazy with the rehab exercises for a few months and seem to be paying the price now. :wall:
It is quite worrying this nerve involvement. I've never had to consult a physio/ doc over this before. Hope it doesn't come to that. Cheers for the advice
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I found other shoulder exercises really help. Now when I start to feel tweaky elbows I work the shoulders and it seems to really help.
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Same as me that. Thought I had golfers but now tahts pretty much gone and now I'm left with nerve pain... Been climbing today and now my elbow feels like I wacked my funny bone too hard... Load of neck stretches and a kind of Egyptian dancing hand movement to 'floss' the nerves! Still hurts everyday for the last 4 months... If you find a cure tell me please hahaha
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started putting those microwavable bean bags on my neck and taking warm baths after climbing... starting to work wonders on nerve pain!!
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For those who have/have had golfers: when you do the eccentric curls (the wrist pronator ones particularly) and you get it to hurt a bit do you find all pain then disappears for a while? This happens for me, seems really strange that aggravating it then makes it hurt less, anyone know how that works?
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tbh I find they do nothing for me... the russian squat lift things with a 5kg dumbell work really well.. but that may just be me..
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If I do the curls and it hurts it took a while for the pain to die a bit then It seems to go... Don't know if its me forgetting... Hahahaha
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seems really strange that aggravating it then makes it hurt less, anyone know how that works?
Breaking down of misaligned collagen so it remodels more linearly?
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Does that mean I should do lots of it? Most thingd online just say something like 3 sets of 10 a day, I'm happy to do plenty more than that if it might help, but obviously dont want to do too much and make it worse in any way.
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3 sets of 20 i read?
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Does that mean I should do lots of it? Most thingd online just say something like 3 sets of 10 a day, I'm happy to do plenty more than that if it might help, but obviously dont want to do too much and make it worse in any way.
I spoke to Dave Mac about this exact topic. As you probably know already Dave is writing a book on climbing injuries at the moment, and so has been researching this in depth. As part of his research he visited the top "tendinopathy" specialist in the UK (London I think he said) who advised:
Repetitions:
Current thinking on best protocol for tendonopathy is 180 - 220 repetitions per day. (Obviously not all at once - I think the idea here is lots of sets throughout the day to constantly stimulate the tendon).
Intensity:
The weight used must be suffiecient to cause discomfort during the exercise. On a "pain scale" of Zero to 10 (where zero is no pain and 10 is agony), the intensity should be around 3-4.
Note: the discomfort should subside within approx. 30 mins following exercise - if it doesn't then reduce the weight. Work up to what is the right intensity - don't just dive in.
However....
You should definitely see a good physio and obtain a correct diagnosis prior to starting any remedial exercise program. Tendonopathy (previously Tendonosis) has become the "go to" self-diagnosis for elbow problems. There are other problems which can produce the same symptoms - so get a proper diagnosis.
Regarding your other question:
seems really strange that aggravating it then makes it hurt less, anyone know how that works?
Very basically, you are using mechanical stimuli to promote re-generation (as opposed to just healing). See here for more information: http://rheumatology.oxfordjournals.org/content/47/10/1444.full (http://rheumatology.oxfordjournals.org/content/47/10/1444.full)
It's very important to point out though that such injuries are often (almost always) a result of either:
a.) Other biomechanical problems such as issues with your shoulder / back (again see a physio).
b.) Poor training methods / technique
Ideally you need to address these underlying issues if you really want to resolve the problem in the long term. Invariably programs to correct these things take much longer (and are f**king boring), maybe months or even years. It really comes down to how committed you are.
I hope you find the above useful, best of luck.
R
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Good knowledge, thanks
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whens the book out? any idea? and cheers
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Same as me that. Thought I had golfers but now tahts pretty much gone and now I'm left with nerve pain... Been climbing today and now my elbow feels like I wacked my funny bone too hard... Load of neck stretches and a kind of Egyptian dancing hand movement to 'floss' the nerves! Still hurts everyday for the last 4 months... If you find a cure tell me please hahaha
Sounds like ulna nerve entrapment. Get a physio to check the origin in the neck for tightness and then the full pathway through the shoulder (and pec minor), tricep and forearm for any areas where it may be sticking. If you have golfers elbow the forearm may be where the entrapment is.
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whens the book out? any idea? and cheers
Sorry I don't know. It was meant to be finished this summer - but I hear it's taking longer than expected.
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thanks anyway and yeah man it is a trapped nerve... hot bean bags on the neck are working so guess its there.... f**king sucks
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So much of clinical advise around tendon injuries has taken an about turn in the last 15 years it's really worth obtaining the most up-to date information from a good physio (e.g. FASIC).
Examples are:
1.) Old advise was extended period of rest - Current advise is to exercise (following correct protocols not hitting the campus!).
2.) Old thought was that pain caused by inflammation - Now we know that tendonopathy is non inflammatory (so ditch the ibuprofen!).
I sometimes feel like we (climbers) are obsessed with self diagnosis - I don't understand it. We happily spend £100 on new pair of climbing shoes but we seem reluctant to spend £35 on a session with a physio to get a proper diagnosis.
Again FASIC are extremely good - but I'm sure there is an equivalent at Sheffield Uni. (and there definitely is at Loughborough Uni.)
It'll be the best £35 you can spend.
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For those who have/have had golfers: when you do the eccentric curls (the wrist pronator ones particularly) and you get it to hurt a bit do you find all pain then disappears for a while? This happens for me, seems really strange that aggravating it then makes it hurt less, anyone know how that works?
The hypothesis behind eccentric exercising is that you are overloading the area to provoke a healing response.
Tendonosis - develops slowly with oversuse rather than down to a specific incident - is thought to be a degeneration in the tendon rather than inflammation. Repeated overload causes microtrauma. This is usually A Good Thing because repair occurs and the tendon is strengthened. If the microtrauma is occurring faster than the repair process can cope with, the tendon eventually breaks down in places. This is tendonosis. Because there is little or no inflammation (the usual healing process) no healing occurs. Rest is not helpful.
Most of the successful tendonosis treatments involve stirring things up a bit (through heavy exercise or injecting something that irritates the area) to deliberately cause a little inflammation in order to kick-start healing. So the exercises should hurt a bit but feel better after.
There are probably also neurophysiological effects with exercise, which is why sometimes the response is quicker than you might expect, but I'm hedging my bets a little here!
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Most of the successful tendonosis treatments involve stirring things up a bit (through heavy exercise or injecting something that irritates the area) to deliberately cause a little inflammation in order to kick-start healing. So the exercises should hurt a bit but feel better after.
Ok, so should I not be icing after these exercises then, since I want that inflammation?
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Ok, so should I not be icing after these exercises then, since I want that inflammation?
In theory, no you should not. In practice I would experiment with and without.
My uninformed speculation is that ice will have more of a neurophysiological effect than anything here as the amounts of inflammation are tiny. It's not like we are dealing with a big, red, swollen knee (I'm a big fan of ice and have been known to carry a thermos of the stuff to the crag but I'm not sure if it is more curative than paracetamol much of the time).
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Hi Duncan,
I don't mean to be critical but what you have written is out of date / and or factually incorrect. I think it's important to point this out to anyone reading it.
The hypothesis behind eccentric exercising is that you are overloading the area lengthening the tendon under load to provoke a healing response.
Tendonosis develops slowly with oversuse rather than down to a specific incident - is thought to be a degeneration in the tendon rather than inflammation. Repeated overload causes microtrauma. This is usually A Good Thing because repair occurs and the the tendon is strengthened. If the microtrauma is occurring faster than the repair process can cope with the tendon eventually breaks down in places. This is tendonosis. Because there is little or no inflammation (the usual healing process) no healing occurs. Rest is not helpful.
This isn't aligned with current clinical thought. This used to be the understanding but it has been proven not to be the case. The term Tendonosis is now redundant and was replaced with "Tendinopathy" to get away from this school of thought.
Tendonopathy is not a degenerative repsonse - it is a failed healing response.
Most of the successful tendonosis treatments involve stirring things up a bit (through heavy exercise or injecting something that irritates the area) to deliberately cause a little inflammation in order to kick-start healing.
This is incorrect. Firstly - "heavy exercise" isn't thought to be what causes a response. Clinical thought is that is the pattern of tendon loading, with its force fluctuations, rather than the magnitude of the force, which is responsible for the therapeutic benefit.
Secondly - "injecting something" I assume you either mean salt water or Corticosteroid. Neither are recommended anymore, and the therapeutic benefit of Corticosteroids is not due to "stirring things up".
Lastly, Tendonopathy is non inflammatory.
Again, sorry if this seems critical - it's not. I can point you in the direction of the current research and clinical papers if it is something your intersted in.
Cheers
R
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Hi Duncan,
I don't mean to be critical but what you have written is out of date / and or factually incorrect. I think it's important to point this out to anyone reading it.
The hypothesis behind eccentric exercising is that you are overloading the area lengthening the tendon under load to provoke a healing response.
Tendonosis develops slowly with oversuse rather than down to a specific incident - is thought to be a degeneration in the tendon rather than inflammation. Repeated overload causes microtrauma. This is usually A Good Thing because repair occurs and the the tendon is strengthened. If the microtrauma is occurring faster than the repair process can cope with the tendon eventually breaks down in places. This is tendonosis. Because there is little or no inflammation (the usual healing process) no healing occurs. Rest is not helpful.
This isn't aligned with current clinical thought. This used to be the understanding but it has been proven not to be the case. The term Tendonosis is now redundant and was replaced with "Tendinopathy" to get away from this school of thought.
Tendonopathy is not a degenerative repsonse - it is a failed healing response.
Most of the successful tendonosis treatments involve stirring things up a bit (through heavy exercise or injecting something that irritates the area) to deliberately cause a little inflammation in order to kick-start healing.
This is incorrect. Firstly - "heavy exercise" isn't thought to be what causes a response. Clinical thought is that is the pattern of tendon loading, with its force fluctuations, rather than the magnitude of the force, which is responsible for the therapeutic benefit.
Secondly - "injecting something" I assume you either mean salt water or Corticosteroid. Neither are recommended anymore, and the therapeutic benefit of Corticosteroids is not due to "stirring things up".
Lastly, Tendonopathy is non inflammatory.
Again, sorry if this seems critical - it's not. I can point you in the direction of the current research and clinical papers if it is something your intersted in.
Cheers
R
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Ok, so should I not be icing after these exercises then, since I want that inflammation?
abarro81: tendonpathy is non inflammatory, you don't need to use either ice or ibuprofen after exercise.
However....you might want to try and use ice / ice water more generally to promote increased blood flow as a result of reverse vaso constriction ("Lewis reaction"). Which has been observed to result in increased healing:
Use ice water for this treatment for approx 30 mins. You will need to use enough ice so as is required to promote 'Lewis Reaction' after 5-10 mins (the area of submerged will turn pinky / red).
Too much ice and your elbow will look white and be extremly cold.
Ideally the water will be cold but your elbow should feel warm by the end of the treatment.
Hope that's helpful.
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Hi rosmat,
I'd be interested in some links to the current research (bit lazy of me to ask for them on a plate, but since you've offered ;))
Cheers
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Hi rosmat,
I'd be interested in some links to the current research (bit lazy of me to ask for them on a plate, but since you've offered ;))
Cheers
Hi,
My pleasure - glad your interested.
*Note: the majority of studies into Tendinopathy have focused on the Achilles tendon, in part because this an issue experienced by people in high participation sports such as footballers / runners. There has been limited research into tendons which insert at the elbow - but the underlying principles remain the same.
Here you go:
Conservative management for tendinopathy: is there enough scientific evidence? (2008)
http://rheumatology.oxfordjournals.org/content/47/4/390.full (http://rheumatology.oxfordjournals.org/content/47/4/390.full)
Management of Tendinopathy (2009)
http://ajs.sagepub.com/content/37/9/1855.full (http://ajs.sagepub.com/content/37/9/1855.full)
The mechanism for efficacy of eccentric loading in Achilles tendon injury; an in vivo study in humans. (2008)
http://rheumatology.oxfordjournals.org/content/47/10/1493.full (http://rheumatology.oxfordjournals.org/content/47/10/1493.full)
Eccentric Loading, Shock-Wave Treatment, or a Wait-and-See Policy for Tendinopathy (2007)
http://ajs.sagepub.com/content/35/3/374.full (http://ajs.sagepub.com/content/35/3/374.full)
I hope that is of help,
R
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Cheers for that, something to keep me entertained inbetween drinking coffee and gazing forlornly out of the window at the incessant rain...
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Brilliant thanks
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Hmmm... As with most research of this type, it doesn't seem very inspiring... The answer to the question posted by the first article would (unsurprisingly) seem to be "No". I do use eccentric loading programmes but it does seem to be based more on the hint of "promise", rather than data obtained from high-quality RCTs;
Kearney R, Costa ML. Insertional achilles tendinopathy management: a systematic review. Foot and Ankle International 2010; 31 (8 ) : 689-694
The article by Rees et al (2008) whilst interesting, did strike me as being flawed (small number of subjects (yawn), healthy subjects (i.e. not necessarily representative of diseased tendon)).
Rompe et al (2007) demonstrated that eccentric loading is about as effective as shock-wave therapy, again not massively inspiring?
http://publications.nice.org.uk/extracorporeal-shockwave-therapy-for-refractory-tennis-elbow-ipg313/guidance (http://publications.nice.org.uk/extracorporeal-shockwave-therapy-for-refractory-tennis-elbow-ipg313/guidance)
I can't comment on the second link as I couldn't access it.
The studies are also a little older than I was hoping (lazy and ungrateful! ;)).
Overall, none of this strikes me as especially good quality evidence, but as I've already stated, I'm a bit lazy today (it is friday afternoon) and there may be a wealth of stuff out there that I don't know about. Maybe.
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I agree that there is still a wealth of research that needs to be done.
However, one thing I find positive is that the majority of the studies in the last 5 years do generally agree on at least the following:
1.) Eccentric loading is successful as a therapeutic intervention for Tendinopathy (although the mechanics are not yet fully understood).
2.) Tendinopathy is not de-generative - it is a healing response failure.
3.) Tedinopathy is not inflammatory.
Speaking from a personal perspective I have found eccentric loading to be very effective, and I've been surprised by the rate of improvement observed.
Lastly, apologies about the second link it did used to be viewable as full text. I would recommend signing up as there are some very good (and generally aligned) papers.
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Cheers for your reply. It's your first point that interests me most. I'm not disagreeing that studies demonstrate fair potential with eccentric loading, it's just that I've yet to see a well conducted RCT or systematic review that demonstrates a significant positive effect. I make this statement with the massive proviso that the last time I did a proper literature search on this was as a student in 2005, but I have done some less comprehensive searches since.
I'm hoping you can point me in the direction of something a little more concrete! :)
Like I said, I do use eccentric loading in my practice, but there's an inner sceptic in me that's not fully satisfied. Especially since a friend lent me a copy of Bad Science by Ben Goldacre, but that's another story!
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Intensity:
The weight used must be suffiecient to cause discomfort during the exercise. On a "pain scale" of Zero to 10 (where zero is no pain and 10 is agony), the intensity should be around 3-4.
Note: the discomfort should subside within approx. 30 mins following exercise - if it doesn't then reduce the weight. Work up to what is the right intensity - don't just dive in.
Okay so I have been wondering about this. I'm doing eccentrics for my right elbow, and recently have been doing 3 sets of 20 reps at 12-14kg (alternating with 2 sets on my left). This generally produces no discomfort except for a mild ache in my wrist.
Over the weekend I went bouldering in the cold and my elbow got pretty sore (I should have taped earlier and kept my elbow warm). I was still sore today. At the gym I did 3 sets of 15 reps, at 14, 16, and 20kg. Again pretty hard work on my wrist, but only the mildest of discomfort, 1-2 on pain scale at the most.
Too little weight? I don't think my wrist can take much more. Too few reps? Too few sets? Or am I doing it wrong? I'm tending to have my upper arm at 120' rather than 90' as it feels like it's stretching and stressing the tendon more that way. I've tried other angles but just can't get enough discomfort.
I can certainly up the sets in a day. What is the best weekly schedule for this exercise??
P.S. Please change your avatar, I like your elbow advice and the useful depth you've gone into, but the avatar bugs me ;)
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Cheers for your reply. It's your first point that interests me most. I'm not disagreeing that studies demonstrate fair potential with eccentric loading, it's just that I've yet to see a well conducted RCT or systematic review that demonstrates a significant positive effect. I make this statement with the massive proviso that the last time I did a proper literature search on this was as a student in 2005, but I have done some less comprehensive searches since.
The definitive, well-designed, properly powered RCT on eccentric exercise is yet been done. It would cost upwards of £600K but it might well get funded as it is a question that really needs to be nailed. Unfortunately researchers in this area seem to prefer to do mediocre quality underpowered trials on new'n'sexy interventions.
(So someone prove me wrong :tease: ).
At the gym I did 3 sets of 15 reps, at 14, 16, and 20kg. Again pretty hard work on my wrist, but only the mildest of discomfort, 1-2 on pain scale at the most.
Too little weight? I don't think my wrist can take much more. Too few reps? Too few sets? Or am I doing it wrong? I'm tending to have my upper arm at 120' rather than 90' as it feels like it's stretching and stressing the tendon more that way. I've tried other angles but just can't get enough discomfort.
It should hurt more than this. Sounds like you are not quite hitting the spot. Have you tried eccentric supination?
excentric exercise for golferselbow (http://www.youtube.com/watch?v=UHXpMPQ4sNM#)
(or, dare I ask, has anyone who knows what they are doing assessed it properly?)
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Haven't tried supinators, so I will try that. I need a stick.
As for assessment, no, but it's identical to my previous golfer's elbow that was assessed by 3 physios (2 climbing physios) and is responding in the same way.
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I'm finding that I have mild pain when I start the eccentric exercises, which passes by the second set and by the third set I can use more weight. What does this mean, am I cured?
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Haven't tried supinators, so I will try that. I need a stick.
I do mine with a dumbell loaded on one end only. Gripping the threaded bar might not be everyone's cup of tea though!
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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.
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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 (https://sites.google.com/site/healgolferselbow/) eccentric exercises, Tommy's (http://tomrandallclimbing.wordpress.com/2012/11/23/golfers-elbow-a-possible-solution/) yoga stretchs, and Laurent's dictionary pushups (see billbow's comments here (http://onlineclimbingcoach.blogspot.co.uk/2011/02/golferstennis-elbow-etc-what-eccentrics.html)). Will get hold of some weights and do the Athlon (http://www.athlon.com.au/articles/sportslink_pg6-9.pdf) 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.
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Get Ben Goldacre all over that comment.
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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...
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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.
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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 (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).
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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?
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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.
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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 (http://en.wikipedia.org/wiki/Hunting_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.
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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.
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Your water could be a bit too cold.
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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.
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What about Deep heat/ralgex. Does this not do the same thing i.e vasodilation. (my skin certainly goes pink).
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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?
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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! :dance1:
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This is a REALLY good source of info:
https://www.facebook.com/groups/WinterClimbsinSouthWales/585869764761238/ (https://www.facebook.com/groups/WinterClimbsinSouthWales/585869764761238/)
Also some honest feedback on using a 'Armaid'
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This is a REALLY good source of info:
https://www.facebook.com/groups/WinterClimbsinSouthWales/585869764761238/ (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?
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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= (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
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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).
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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
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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). It's a bit tricky to get right though (https://www.youtube.com/watch?v=oHrDtRtLmFg). 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 (http://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
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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/ (http://tomrandallclimbing.wordpress.com/2012/11/23/golfers-elbow-a-possible-solution/)
These shoulder stretches seem worth a try too: Open Book Stretch - Golf Fitness Academy (http://www.youtube.com/watch?v=fS99NEsAkHo#)
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.
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Hey, I've got a golfers elbow at the moment due to fingerboard use :wall:
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.
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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
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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.
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Thanks for your reply. The idea of management whilst climbing appeals to me a whole load more than cessation of activity. Not campussing etc isn't a huge loss as I like rock climbing, not campus boarding.
As I've caught this early it may settle, I can report back in a while with my experiences although as suggested above, individual problems may present similarly but vary a lot.
Having multiple muscles with a common insertion on the medial epicondyle certainly disproves 'intelligent design' though.
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An update for interested parties... (ie if you have golfer's too)
I spent a month doing eccentrics for FCU without progressing, then went to the 919 clinic.
I have Pronator Teres not FCU afflicted so the treatment is outer rotation eccentrics as shown here:
by John Ostrovskis of 919 Clinic (http://www.youtube.com/watch?v=Nb8aAzjLZAs#)
with a twist..as instructed by John O. in fact..
1 set daily. 15 repetitions only. Work the weight progressively upwards till it's quite difficult to complete the set ..'to provocation'.
Sounds counter-intuitive to do scarcely 100 repetitions per week however it's working fine. I've been pretty relaxed about climbing, bumbling on grit for a month though I've just built a patio (and mixed all the mortar) without pain so now am going to up the ante climbing and report back in a bit.
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Anyone know anything about doing bicep curls with golfer's (FCU version mainly I think)? I always assumed it was out since attempting 1-armers makes the elbows feel bad, but I just tried some curls and it felt fine... I guess what I'm asking is: if it doesn't feel like it's aggravating the elbow then is there any reason not to do the odd set of curls?
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what stage is the elbone at?
I'd have thought if its not hurting its probably not an issue. if you think the stresses that climbing puts on your arm would be more than likely be way more than a bicep curl (assuming its not 70kg dumbell!)
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what stage is the elbone at?
I'm in the hideously-slow-but-generally-steady improvement stage. Though I've been in that stage for about 9 months... It's fine climbing 95% of the time, I can fingerboard ok so long as I don't overdo it but campusing or hanging on 1 arm make it hurt.
I'll give it a bash throwing the odd set in and see if it causes any deterioration.
(assuming its not 70kg dumbell!)
I wish!
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I have a re occurring golfers elbow, had for maybe 4 or 5 years. Right on the crest of the boney knob on the radius. It got to the point where campusing was impossible and locking off caused considerable pain. Tried the twisty weighted stick method, which initially worked then started to give me wrist problems, from the twsting action. Reverse curls just aggravated it so they were a no. Then I tried the rolley string on stick device using it for 2 mins x 3 times a day for probably 3 months. I virtually have no problems now and if it starts to come back which it does every few months I just go back to a few treatments a week and it sorts it pretty quick...
:whistle: :smart:
http://crusherholds.co.uk/forearm-and-wrist-exerciser (http://crusherholds.co.uk/forearm-and-wrist-exerciser)
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i'd see how it goes tbh, if it doesn't hurt it might help? who knows - nobody knows (having read ALOT on this over the last week)
but yeah i'd probably not crank 70kg on there!
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Sorry for dragging up an old thread. I've been sat here for 20 mins trying to find some info to help id what I might be suffering from in the elbow department.
The videos and descriptions seem to talk of areas that differ to my elbow pain.
Quite simply if you put your arm on a table to have an arm wrestle, the very point in which your elbow touches the table is where I have pain, if anything about a centimetere towards the upper arm.
The descriptions all seem to describe pain towards the sides of elbows? Can anyone help from previous experience?
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Read this whole thread as golfers elbow was the reason I foudn this forum. There is a few posts in here about the medicin behind the injury but none of them contains what U've been told by doctors and physios here in sweden.
The pain is supposed to be caused by nervecells that has developed in the healing area of the tendoin. In the healing process blood vessels grows to feed the healing and in the same time these blood vessels give life to nervecells there they shouldn't be. The theory is that excentric excercises is better at getting rid of these blood vessels and hence starving the nervecells.
A friend of mine had pain in his Achille's tendoins for 3 years and nothing worked, NSAID's or excentric excercises.
Recently he found out of a treatment performed at a hospital localy to us that seems to be working extremly well. They inject a sclerosing liquid ( no idee what this means) at the actual tears in the tendoin, they find these with ultrasound, and the liquid will "cramp" the blood vessels and stop the blood flow thus starving the nervecells and kill them.
This is the explanation I got.
//Tresor
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Golfers elbow is in the 'runnel' between the pointy bit of the elbow and the next bone nearer to your body (if you're holding your arm next to you). Nice set of exercises here by Tom Randall... was chatting to SteveR of this parish a few weeks ago who had chronic elbow issues for years - and these exercises sorted him out...
http://tomrandallclimbing.wordpress.com/2012/11/23/golfers-elbow-a-possible-solution/
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I'll give these exercises a whirl for a week or two as it can't do any harm besides feeling like you're in some anti-masturbatory self discipline position.
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Would be well worth spending some time on the mobility wod site imo. The "voodoo band" stuff, although sounding weird seems pretty valid. If you dont fancy spending money on the bands iv'e made a reasonable imitation by opening up a used bike inner tube and cutting the valve out. The exercise below feels like the best deep tissue massage in the world, and going through the full range of motion hurts like hell (in a good way)
Bench dip pull up elbow-itis | Feat. Kelly Starrett | MobilityWOD (http://www.youtube.com/watch?v=0dgbCDtqdlI#ws)
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I have been doing these exercises for about 5 days now, along with press ups.
I have to say the pain has eased off considerably.
I even climbed for around 4 hours yesterday.
There may be something to this yoga lark :-\
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More resources on elbow problems here:
http://www.ukclimbing.com/articles/page.php?id=6156 (http://www.ukclimbing.com/articles/page.php?id=6156)
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I don't use UKC as a rule but that's fairly comprehensive.
My eccentric exercises weren't stopping pain, seemed to be getting worse.
Turns out (after seeing Jon) that they WERE effective, my pronator problems are now sorted. But now I've got FCU problems, so different exercises and more patience needed.
He recommended tring a different stretch. essentially yoga purvattanasana, except fingers point back, not forward. certainly seems to nip the epicondyle, so it's doing something. We'll see.
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He recommended tring a different stretch. essentially yoga purvattanasana, except fingers point back, not forward. certainly seems to nip the epicondyle, so it's doing something. We'll see.
I've tried this a bit recently on his suggestion. No idea if it's helping or not, since the elbows have been doing well anyway, but it definitely gets a good stretch going on
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The yoga one was something I came up with when I was seeing John. Eccentrics did nothing and I accidently discovered that this was the only thing that I could find that hurt my elbows. So the theory was that we did that to cause provication and thus help heal the elbows.
I didnt seem to make any progress. I went to see a physio who was focused more on nerve issues and was told that this exercise hurt a lot becuase it put the nerves on stretch. Given that my neural tension is terrible thats why it hurt me so much. So I've now focused on nerve and back work and use the exercise to test progress, Certainly hurts a lot less now when I do it, but have a fair way to go before my nerves are back to normal.
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Some things I have found over the last 5 weeks whilst battling the classic golfers elbow. I let it get to the stage where it was really sore. Totally stupid and I should have stopped climbing hard and started rehab a LOT sooner. I think this has led to it taking ages to heal, rather than probably being a quick fix. Hard trad in particular seemd to really mess it up, presumably because of all the locking off.
I tried all of the recomended eccentric wrist curls, and found it really hard to hit the sweet spot that caused the necesary slight pain in the tendon. Then I found this article...
http://www.climbing.com/skill/prevent-elbow-and-shoulder-injuries/ (http://www.climbing.com/skill/prevent-elbow-and-shoulder-injuries/)
where Dave Mac recomends doing a different eccentric exercise that doesn't need any weights. I have found that exercise was much easier to get the desired pain, without having to lug round bg dumbells. And it's easy to do whilst at work etc.
I've been massaging the spot with one of those armaid things, which also feels like it's ghelping. As well as icing. I've also been doing easy climbing, which seems to make it feel better, and seems to be recomended rather than total rest. I upped it to doing some 7a's this week and it feels fine so far.
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Have you tried Tommy's magic stretch (http://tomrandallclimbing.wordpress.com/2012/11/23/golfers-elbow-a-possible-solution/)?
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A bit, but I find it phenomenally uncomfortable! Mainly due to my face being pressed into the floor. Will persist with it though as a fair few people seem to think it helped.
Seems to me so far though, that no one thing is the magic answer, but a combination of eccentric exercises, stretching, massage and icing will fix it. It just takes a while to figure out the best specific ones for you.
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My Evoluent 3 mouse at work seems to be making a massive difference to mine.
It has the added benefit of confusing anybody who tries to use my PC too. Endless fun.
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I have a trackerball mouse set on an inclined bit of plywood to reduce elbow stress. There is almost no rotation of the forearm, and I think it helped my elbow calm down..
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I learnt to use the mouse with both hands - which helps with twingy bows... I also find touchscreens make things 'different' (not better not worse)...
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I just use a keyboard :P :geek:
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I just use a keyboard :P :geek:
Bet you've got one for you phone too ;)
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Yep, I control my phone from my desktop/laptop, why would anyone do any different? :clown:
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My latest findings, for anyone struggling to get the eccentric exercises to work for golfers:
Basically, if it ain't making your tendon a bit sore whilst doing the exercise, it ain't working. Experiment with doing the exercises (the ecentric wrist curl and the eccentric lowering outwards) at different elbow angles. SO fully straight, a bit bent, 90 degrees and as bent as possible. For me, doing them with my arm bent as much as possible seems to find the sweet spot. It causes moderate pain whilst doing them, and after about a week of it I finally feel like I'm making progress with treatin g the injury, after 8 weeks of not getting anywhere. I have been recomended to do 2-3 sets of 6-8, twice per day, every other day. Afterwards, give it a really good massage, and ice, and also do that on the day off. BAsically really look after it to aid healing. It will definitely feel pretty tender for a bit, but within 12 hours for me, it feels noticeably stronger.
Usual caveat about seeking professional advice etc.
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Next problem. Golfer's is recurring, not badly so but enough to be worrying.
Doing the eccentric curls and rotations, with only just enough weight to cause discomfort at the injury site (12kg curls). This is now making my wrist sore and stiffen up quite a bit. I've been gently stretching and massaging it a bit but it's pretty worrying if it's preventing me from doing elbow rehab.
Help???
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Next problem. Golfer's is recurring, not badly so but enough to be worrying.
Doing the eccentric curls and rotations, with only just enough weight to cause discomfort at the injury site (12kg curls). This is now making my wrist sore and stiffen up quite a bit. I've been gently stretching and massaging it a bit but it's pretty worrying if it's preventing me from doing elbow rehab.
Help???
Current best regime according to Julian Saunders (as of about 4 months ago):
3 x 8 reps, twice a day, day on day off, heaviest weight you can manage, should hurt whilst doing it. Also massage hard the sore bit around the bone (not directly aggravating the nerve on the epicondyle) 5-10 mins/day on the "on" days. You are trying to stimulate the tendon to heal so needs to be quite aggressive.
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I haven't read that but I would add: annoying the actual epicondyle does not sound wise, though finding where the sore point on the tendon is (will vary, mine was in worst place, actual tip of insertion) and massaging tissue up and around might be good. Maybe worth considering that a tight muscle+ tendon is placing tension on the injured site so massage to relax the muscle body might be worth a punt.
What fixed mine (after 18 miserable months) Fiend was this:
Give up climbing for a few months as nothing worked. Resume again at utterly trivial level. Build back up to normal incrementally over 2/3 months.
I also did eccentrics with heavy weights. I did 2x 25 reps at whatever kilos were knackering
Tom Randall's stretch, making sure to be stretching up with head&torso and legs at the same time, so spine quite arched, quite a powerful stretch.
One question. There are two forms of the eccentric loading. Do you know which one to do for you? Your condition can change over time- mine did.
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Eccentrics worked for me before, along with other stuff.
The problem is that now the eccentrics are aggravating and stiffening my wrist - any ideas / suggestions??
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Play around with the protocol to protect your wrist, there is no set miracle package. And do some counter exercises/stretches for wrists
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eccentrics, straight arm stretching (palms facing out push back of hands into hips and fingers to floor with shoulders back). Also I've heard folk banging on about bromelain supplements in order to speed up tendon healing. I've dabbled but don't know if my improvement was down to the first two, or just time, or it was some mad pinapple voodoo ?
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Play around with the protocol to protect your wrist, there is no set miracle package. And do some counter exercises/stretches for wrists
I'm not really sure how to do that?? The current weights seem only just enough to stimulate the elbow tendon, and I'm doing them with a fairly standard position and fairly standard ROM from what I've seen. I'm pretty sure my wrist has to move back down from the inner forearm for ecc curls and rotate out as far as possible for ecc rotators and that's what aggravates it - specific ideas to avoid that would be welcome!
I am doing stretches and massage for the wrist now, I'm not sure what counter exercises to do though??
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Had recurrent trouble with golfers’ over the last years. Eccentrics worked for me to a certain extent, but did not provide durable relief. As soon as I restarted to do lock-off and compression exercises the trouble started again.
And yes, I’m aware those are known to be hard on the elbows. But still fun to train. Wisdom is not always a question of age ;)
Eight weeks back, I came across this link in the ‘tight forearm’ thread (thanks jfdm!):
https://youtu.be/mSZWSQSSEjE
As the static forearm stretches I tried before did not really seem to work for me, I followed this ‘pulsing’ advice and wrist prep sequence from the GMB guys for the last weeks and especially the elbow rotations working the pronator (2’33’’) felt as if they really hit the right spot. Overly tight pronators are one of the many possible causes of golfers’, so this is obviously the issue for me.
Four to six weeks later my elbows were completely painfree and even after starting to do lock-off / compression exercises again (while religiously maintaining the wrist prep work before and after), my elbows still feel good.
Also nice: They can be done almost anywhere, even at a desk and are really quick too. Easy to incorporate in routine and to make a habit out of it.
Hth
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I found this really helped...
http://ukbouldering.com/board/index.php/topic,27038.msg521884.html#msg521884
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Back once again with the renegade elbow.
Been doing the usual theraputic bollox ofc.
Also I've tried eccentric lat pulldowns using one of those double rung type things as a theraputic exercise. Pull it down with both arms, favouring the uninjured left, let it go slowly back up using the injured right. Quite sore for the first half of the movement, eases right off towards full extension. I can see my forearm muscle visibly stretching out a lot which makes me think it might do the recommended "load the tendon under extension" shizzle.
Thoughts??
Edited for clarity - I'm wondering about the eccentric pulldowns as rehab.
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I assume golfers. I was plagued for years and that sounds like just the sort of thing that agrivated it! Been pain free for a few years now and key was buying some cheap paralettes and doing various things with those. I suspect I had weak wrists and shoulder girdle and static holds helped with that. I found anything that aggrivated it a bad idea although worst thing was doing nothing so keep trying different things and good luck!
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I used to get loads of bother with this in the early 2000s as well but been ok for years. Occasionally get slight niggle coming back but I find the usual stuff seems to sort it in a week or so. Realise this isnt that helpful as you have already done this. Have you made sure you get the level of "aggravation" right when doing the standard eccentrics - think it is in Macleods book and some tendinopathy discussion he linked a few years ago.
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loads of stretching and even a massage to release pressure before starting rehab exercising was essential for me. These days I keep on top of golfers and tennis with a foam roller to keep tightness away.
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For TE antagonistic exercises ive found a theraband much better than using a dumbbell/weight. As in it seems to have a greater effect.
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Back once again with the renegade elbow
Thoughts ?
If you are really bothered about fixing this, you’ll go to see a good physio. Someone who will diagnose your injury, rather than tell you what helps theirs.
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Okay, I guess my recent post was a bit casual and not well written to ask the question I have.
I have a golfer's elbow flare up in my right arm. From having chronic golfer's elbow in my left arm for several years, I know what it is. From having managed, alleviated and reduced that left arm golfer's elbow to an uninhibitive state (it's actual complete disappearance coincided with a couple of reflexology sessions which is quite possibly an entirely different discussion), I know what usual protocols (warming up well, taping during climbing, press-ups after climbing, regular eccentric wrist curls and rotations, ice if needed, massaging the tendon-muscle join and lower muscle belly, stretching) work for me.
The question is: would the exercise I described (eccentric pull-downs) work as a rehab exercise along the same principles as eccentric wrist curls etc (loading the tendon as it's extending)?? The discomfort and clear extension indicate so, but if anyone is aware of either any dangers (other than the obvious "don't overdue it") or counter-arguments ("this won't work compared to eccentric wrist curls because of xyx") then I'd appreciate them.
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I'm trying to picture the eccentric pull downs, but it sounds like it wouldn't quite hit the right muscles, but if you're getting the "familiar pain, easing with reps" then it might be doing the trick?
Would seem like it would not be doing the right thing as there's very little wrist flexion (so it's almost an isometric exercise). that said....isometric & high loading = good tendon loading and minimal "aggravation", so you might be on to something.
How recently did you get the onset of issues?
When I got tennis elbow in my right arm, it took moths, but when I figured out what worked for me I was good in 2-3 weeks. I then got it in my left and thought "great, I know exactly what to do", but that was a fresh inury, and the high intensity/low reps routine made it worse, but light weights and more reps seemed to help (tendinosis/tendinitis innit),
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Okay, I guess my recent post was a bit casual and not well written to ask the question I have.
I have a golfer's elbow flare up in my right arm. From having chronic golfer's elbow in my left arm for several years, I know what it is.
Sorry if my response seemed abrupt, but as someone who is frequently injured, I am quite averse to wasting any further time barking up the wrong tree or persisting with ineffective solutions. I’d rather be climbing.
Is it FCU or pronator teres which is giving you grief?
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@Fultonius - I see what you mean about the lack of wrist flexion. I'm 3 weeks into it. Have been doing eccentrics for the last 2 weeks, although I'm struggling to get enough loading to provoke discomfort in the tendon area.
@MRJR - a bit of both I think. Feels more like PT in the tests but more like FCU in general usage and level of aggravation with non-wrist-rotating movements.
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You need to find out what to target because those injuries demand different protocols. I appreciate physio fees hit the budget pretty hard but my logic is they save a lot of time by speeding recovery. Money :devangel: time.
Good luck with it whatever you decide.
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Well.....if you can recommend me a reliable, climbing-knowledgeable Manc physio, I can give it a try....
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Well I usually schlep across to Sheffield to see Jon Ostrovskis. He’s great, sees a lot of climbers. He does Zoom consults too https://www.919clinic.co.uk/
I know some of our Olympic team come over from Sheffield to see Jeff Ross at Wilmslow Total Fitness down the A34. Jeff is excellent- all his physios are, esp Steve Renshaw (previously at LFC under Klopp). Have seen both but prices are... not trivial.
https://www.harrisandross.co.uk/our-clinics/wilmslow-physiotherapy/
Jon O is good.
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I used to see Ozzy all the time when I lived in Sheff so a lot of my understanding of injury treatment comes from him, along with some from this forum and a bit from DMac.... Probably cheaper including diesel than the Total Fitness team :devangel:
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I think for joints like shoulders Jeff and co are great. My philosophy was always pay a fortune for top notch advice once. Loads cheaper than multiple cheaper visits to physios who can’t fix you.
Pretty sold on the ‘potter at Burbage + Jon O’ combo, fixed my elbow (not golfers) this summer.
Ironically I can walk to Total Fitness.
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Bump - maybe its a co-incidence, but since doing some TRX stuff (light/gentle) 2-4 times a week my Golfers is much improved.... It was a teeny bit 'feely' last night after doing some one arm PU training (a usual trigger) and I did some prone IYT's and it felt better after - and fine in the morning (Prone T's especially seemed to help).
N=1, who knows etc... but thought I'd post it up.
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Does anyone have experience with returning to training after rehabbing golfers elbow and finding yourself pain free (but probably injury prone)?
Last year I ended up in same boat as many of the people in this thread. January I was getting back into training after a layoff and went a bit too hard too fast probably because it was easy to re-gain some strength but without conditioned tendons. Did a ton of crimp pull ups and ended up with a very irritating right elbow injury.
I’ve done all the things I should have done (mostly) including seeing Huffy who worked out I had some strength imbalances, much weaker on the right hand side. So I focused on correcting those imbalances primary rather then targeting the tendon.
With some time and physio things are a lot better. This month I’ve been doing more climbing and more strength stuff, but I haven’t done a single pull up.
I’m pretty keen to work some weighted pull ups back in (I can’t just go and climb all the time, with work and kids). When I was climbing my best and at my strongest I found them a really helpful part of my routine.
My first thoughts are:
1. Always warm up fully
2. Do pull-ups on a bar with weight for strength. Slowly build up.
3. Do hangs on a crimp for fingers but don’t do any crimp pull ups at all.
Does this seem reasonable? Has anyone been here and been able to return to pull ups without re-aggravating the injury? How slow did you go and was there anything you avoided? Does it seem sensible to can the crimp pull ups?
Thanks!
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I would say get the problem tissues as strong as you can before starting to do too much climbing style loading.
So for golfers, I guess whatever the physio gave you - do it with much bigger weights, low reps and plenty of rest. Also, avoid volume at all costs in climbing and climbing training. Stop training when you have a bit of power loss.
Happy for other to agree/disagree, add, amend this thought.
I did this for my TE and it's never come back.
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I would say get the problem tissues as strong as you can before starting to do too much climbing style loading.
So for golfers, I guess whatever the physio gave you - do it with much bigger weights, low reps and plenty of rest. Also, avoid volume at all costs in climbing and climbing training. Stop training when you have a bit of power loss.
Happy for other to agree/disagree, add, amend this thought.
I did this for my TE and it's never come back.
That sounds very sensible. I’ll work on progressing up the weight from here. Actually not quite at the fully prescribed routine yet because it turned out it was harder than I can do!
I’m quite fortunate I’m basically forced in to short and often sessions right now. I’m either in the gym which opens an hour before work, or the climbing wall that closes a couple of hours after, so some automatic limitation.
Climbing itself has never seemed to be intense enough to cause a problem, was just the crimp pull ups but I think I’ll be pretty mindful of volume with both climbing and the training for a while.
Thanks a lot, that’s helpful advice!
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I had horrible problems with golfers’ in both elbows which took several years to fix. All fine now. Occasionally it feels tight but always settles. My solution:
I had a layoff, born of frustration really. Resumed climbing at a very gentle level (ie not even as much as a good warm up) and built up to previous level in small regular increments.
Kept doing forearm dumbells ( whether for FCU/Pronator Teres according to what hurts) regularly, slow and heavy. Did them especially if the forearm felt tight- it’s a strengthening exercise for the tendon which responds slowly.
Did various weights (Turkish get ups, dumbbell press, external rotation etc) to get stronger shoulders. I think that was really important- the elbows work from the platform of stability provided by the shoulders, they should be solid.
I do these exercises once a week as a matter of basic conditioning now. My fingers are getting hammered this year with deadhangs and board climbing but there’s no recurrence.
That’s what works for me.
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I had horrible problems with golfers’ in both elbows which took several years to fix. All fine now. Occasionally it feels tight but always settles. My solution:
I had a layoff, born of frustration really. Resumed climbing at a very gentle level (ie not even as much as a good warm up) and built up to previous level in small regular increments.
Kept doing forearm dumbells ( whether for FCU/Pronator Teres according to what hurts) regularly, slow and heavy. Did them especially if the forearm felt tight- it’s a strengthening exercise for the tendon which responds slowly.
Did various weights (Turkish get ups, dumbbell press, external rotation etc) to stronger shoulders. I think that was really important- the elbows work from the platform of stability provided by the shoulders, they should be solid.
I do theses exercises once a week as a matter of basic conditioning now. My fingers are getting hammered this year with deadhangs and board climbing but there’s no recurrence.
That’s what works for me.
Similar story for me, had golfers in both elbows, rehabbed them and then did a metric ton of conditioning for my shoulders, upper back and arms and they have not returned even though I’m trying harder compression stuff now, both wide and narrow.
I think strengthening all the surround areas is key, just being consistent week in, week out with it is so important to good body maintenance.
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I think I remember slabhappy posting that she does single rep turkish getups on the minute. You are also saying doing low reps and heavy.
I was doing a weight that felt an effort to do six reps. Should I be doing a weight that is an effort to do one rep? I'm guessing I should warm up with eg six reps of a low weight before doing such single reps?
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I think I remember slabhappy posting that she does single rep turkish getups on the minute. You are also saying doing low reps and heavy.
I was doing a weight that felt an effort to do six reps. Should I be doing a weight that is an effort to do one rep? I'm guessing I should warm up with eg six reps of a low weight before doing such single reps?
Are you injured?
They're quite a complex manoeuvre, so perhaps better to stick with the 6 reps. The main thing about low reps is that they stress tendons and ligaments (promoting growth) without building up too much fatigue.
If you're injured, pain is the usual good reference. Fresh injury you want almost no pain, but after a few weeks you might need to promote a 3/10 pain to get the damaged tissues to respond, form 6-8 weeks onwards you might need to even ramp it up to 6/10!
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I was really viewing the turkish getups as a general injury prevention measure.
I've got a forefinger A1 joint injury of some sort from eleven days ago. It seems to be getting better.
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I think I remember slabhappy posting that she does single rep turkish getups on the minute. You are also saying doing low reps and heavy.
I was doing a weight that felt an effort to do six reps. Should I be doing a weight that is an effort to do one rep? I'm guessing I should warm up with eg six reps of a low weight before doing such single reps?
I'd say the key thing to consider in your planning is that form really, REALLY matters with TGUs. It's about being able to control and stabilize the weight while the rest of your body goes through a wide range of motion in relation to the raised arm.
Which, for me, is one reason for doing singles with decent rests. On the minute works well for me (bearing in mind that if you're not rushing, a single TGU can take 20-30 seconds of that minute), but you can go longer -- it can work nicely to just take as long as you need between reps, and go again as soon as you feel you can do so cleanly.
I'm not doing singles in a "single rep max" sense, I'm doing singles with the goal of getting 10 really good quality reps, if that makes sense?
You want to concentrate on perfecting the form before you increase the weight; if you're struggling or in danger of having to drop the kettlebell at any point in the movement, it's too much.
If you want, you can get even more of a stability challenge (and bonus grip and wrist work!) out of a much lower weight kettlebell by doing the TGU with the kettlebell in the "bottoms-up" position.
I believe one of Dan John's strength standards is a TGU with a half-full plastic cup of water balanced on your hand. Preferably done on a waterproof surface.
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Thanks slab_happy, that is really helpful. I was thinking you were meaning a one-rep-max type weight (ie a weight at which I wouldn't be able to do two reps). I'm using a dumbell not a kettlebell since that is what I have.
I've been doing turkish get ups off and on for about 15years now but I've always worried my form was probably bad. You saying about the importance of form makes me think I ought to try and video myself with my laptop and then compare to the how-to videos online. I think if I were to use a cup of water, it wouldn't spill though.
Is your emphasis on form because poor form can harm the knees or what?
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Great, a lot of the focus of the physio is shoulder and upper back with a bit of brachioradialis and lock off strength.
I started doing top heavy dumbbell pronator teres style rotations again this month but found my wrist really hurt with them at quite a light weight. Doing it with a normal dumbell seemed better for the wrist.
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I started doing top heavy dumbbell pronator teres style rotations again this month but found my wrist really hurt with them at quite a light weight. Doing it with a normal dumbell seemed better for the wrist.
Might not do much for PT if that's where the problem lies, though. You may need to build up wrist strength gradually before you're able to fully load the PT tendon with a heavy weight. I've experienced that. It all takes patience. Worth it, though.
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Thanks slab_happy, that is really helpful. I was thinking you were meaning a one-rep-max type weight (ie a weight at which I wouldn't be able to do two reps). I'm using a dumbell not a kettlebell since that is what I have.
I've been doing turkish get ups off and on for about 15years now but I've always worried my form was probably bad. You saying about the importance of form makes me think I ought to try and video myself with my laptop and then compare to the how-to videos online. I think if I were to use a cup of water, it wouldn't spill though.
Is your emphasis on form because poor form can harm the knees or what?
First off, thanks for giving me some impromptu psyche to go and do some! They're always good for me and I really need to do more as part of my project to rebuild strength after last year's illness clusterfuck.
As I understand it, the emphasis on form is because you're trying to build control and stability (especially in the shoulder joint) through the whole exercise. Trying to make it smooth and polished is harder (though also safer) than doing a desperate flail to get the weight up there by any means necessary.
And there are details of form which can create extra challenge or nuance, e.g. doing the high hip bridge to sweep your leg through rather than rearranging your legs on the ground.
In my experience, if you try to make it smooth and polished, especially going slowly, it will ruthlessly expose all those little points where you wobble or have to lurch that little bit to get through a step on momentum (my knees always thump the last few inches to the ground on the descent). I have a selection of slow music specifically for doing TGUs!
I'm not aware of it being any more prone to harming your knees than any other exercise with a lunge/step component, but then it's not going to be less likely to either, so if your knees are wobbly, obviously better keep an eye on them.
But in my experience the major injury risk is losing control of the weight, trying to hang onto it for that bit too long as it starts to drop, and wrenching one of your joints. Train yourself to NOT try to save the floor/nearby furniture at the expense of your own joints!
Also a bunch of climbing walls seem to have kettlebells now, so worth having a play with them if you get the chance. Just because the weight's off-centre, you get an extra bit of stabilization challenge.
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Hi Monk. Fully paid-up member of the golfer's elbow club here. I've got myself back to heavy (150% BW) weighted pull-ups again, and I actually think they help a lot, when done right. However, much like someone with substance abuse issues, I continue to regard myself as being at constant risk of relapse. I'll give you my tuppence.
Everyone's experiences on what works for them will differ a little - I suspect this is because what climbers call "golfer's elbow" is typically an acute injury of one of a variety of load-bearing structures near the medial epicondyle - some people heal this up fine and think they have the answer to golfer's elbow. For those of us who didn't allow it to recover properly the first (or second or third) time, it becomes chronic. You get scar tissue, which then means nerve fibres that sense pain in response to loads that previously were pain-free. Recovery/lifelong management involves avoiding aggravation (both to avoid actual injury and avoid detrimental feedback cycles in response to pain), and slow progressive loading to both strengthen all the structures involved and to desensitise the hypersensitive neural pathways (I am not an expert in this area but I've found this construct helpful.)
Golfers is incredibly easy to aggravate, with training, climbing, or even over-enthusiastic rehab. You will learn what does it for you! For me it's deep lock-offs in pronation (a la crimp pull-ups). Ease off, back away from these, it will be better in a few weeks. Sometimes it remains "tight" and then gets abruptly better after a day's cautious climbing.
I never found dumbbell eccentrics helpful. Slow controlled progressive loading of all relevant structures, and avoidance of irritation/aggravation are key. Heavy isometrics may be just as good or better than eccentrics (there's evidence on this). On occasions I've done weird things like really steep juggy climbs trying to keep my arms as straight as possible, and that has really helped. When you start doing pull-ups, by all means build up weight progressively but consider avoiding deep locks altogether until the whole chain is much stronger. Terminate the movement just above 90 deg of elbow flexion. Be strict about form ie scapular retraction etc. No doubt stronger shoulders will help, so I echo others' advice on this.
Avoid doing rehab exercises just because they "seem to be hitting the spot" - this is probably just mild irritation, which will aggravate if repetitive enough!
Don't do too much rehab all at once! Need to separate out different activities to assess their individual impact.
Stretching the forearm by forced wrist extension + elbow extension may just compress and irritates the tendon. Can do Tom Randall stretch (YouTube vid somewhere) - wt on palms not fingers, avoiding elbow hyperextension. I found kneeling on my own forearm muscle (not the medial epicondyle) and clenching my fist a much better way of loosening up the muscle.
Some of this sounds bonkers as I write it down, but it continues to work well for me to at least keep training, climbing and (maybe?) progressing despite not being totally "cured".
Good luck!
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When I first injured the elbow I did some pronator teres stuff, built up slowly without wrist issues. Huffy said that was probably useful to begin with but felt the focus should then be on the overall strength deficiencies going forward and so I stopped after seeing him.
This Jan, after a bit of a post baby arrival lay off of everything I thought maybe I should do some preemptively, and the wrist pain was horrible. Maybe a sort of De Quervain type thing, certainly in that area. It’s something I also had problems with in the past. I don’t think this means I shouldn’t do the standard rotations, but I have to be really mindful of the wrist.
All of the input has been really useful here, thanks very much. I think going forward I will put some focus into both wrist strengthening and maybe some pronator teres work building up slowly. But primarily I’ll work on the additional strength stuff, shoulders etc and try and get that strong.
I will add in some body weight pull ups on a bar when fully warmed up as a start point to progressing back to weighted pull ups. Just low reps to start with just to see how it’s all feeling, and stop if any issues. Really focus on form, which I basically never have thought about much before as it seemed like such a natural movement. Deep locks definitely seem to be an issue for me, so great advice on terminating the movement a bit early. I’ll totally can finger tip pull ups for now, maybe revisit in the future, but realistically I can get more than adequate gains from standard hang protocols, so that will be the focus for fingers.
Then yep, gotta be sensible about climbing on a board and stuff and stopping whilst still strong.
Also never even thought about doing TGUs, I’ll have a read and see if I can find someone to show me how to do it right!
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Also never even thought about doing TGUs, I’ll have a read and see if I can find someone to show me how to do it right!
They're good and weird and really do seem to hit something which other exercises don't!
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With TGU you also can revel in being part of an ancient tradition. Think of all those Turkish wrestlers centuries ago, slathered in olive oil, taking care of their shoulders. https://en.wikipedia.org/wiki/Oil_wrestling
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Sadly, as far as I know, there's no solid evidence of Turkish get-ups having any actual association with Turkey.
They first appear as a 19th-century strongman exercise (think dudes in leopardskin leotards with handlebar moustaches), and realistically they probably got called "Turkish" because it was a way to make them sound ~exotic~ and impressive.
(Also I feel like olive oil and TGUs would be a bad combination ...)
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That's not sad, it's tragic.
Leopardskin moustached dudes are a bit of a consolation though.
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This thread is great as I have nothing to add. When I first started reading climbing social media too many years ago there would be all kinds of nonsense about how to help people with elbow (tendon) pain. I'd also read of shocking advice and practice by medical professionals. Gratifyingly, this is all much less likely now in the UK.
Sadly, as far as I know, there's no solid evidence of Turkish get-ups having any actual association with Turkey.
They first appear as a 19th-century strongman exercise (think dudes in leopardskin leotards with handlebar moustaches), and realistically they probably got called "Turkish" because it was a way to make them sound ~exotic~ and impressive.
(Also I feel like olive oil and TGUs would be a bad combination ...)
I was thinking of a mildly satirical post about Turks coming over here with their get-ups and why couldn't we use proper British exercises (with a picture of your Victorian chap lifting an implausibly large dumbbell). Entertained to read it's an example of branding/mild Orientalism!