[gremlin]

Hi,

I'm struggling at the moment with a dull ache on the inside of my left elbow. A good poke about reveals the source of the pain seems to be a thick tendon at the bottom of the bicep, where it meets the inside elbow area.
I can still climb and with little or no pain but afterwards I notice the problem, particularly when fully contracting the arm.

Did a quick search on the forum (for bicep) but nothing seemed to match my symptoms.

Any ideas? How long have I got to live? :-)

Ta.

[SA Chris]

That's not your bicep, that's your elbow.  Look up golfer's elbow.  Or tennis elbow. One or the other anyway.

[sidewinder]

Then probably realise that it's not your elbow but your shoulder that's the root cause....

[chris_j_s]

Here's the usual dodgy elbows link!

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

[SA Chris]

Then probably realise that it's not your elbow but your shoulder that's the root cause....

Because your elbow bone is connected to your shoulder bone.

[shark]

Did a quick search on the forum (for bicep) but nothing seemed to match my symptoms.
Ta.

You have probably strained the brachioradialis - its a common climbing injury. Try freezing water in a yoghurt pot and pressing it into the sore spot a few times each night before bed.

That will be £30 please. Or buy a UKB hoodie instead: http://www.v-outdoor.co.uk/products/index.php?prodCategory=Clothing

[davidbulley]

I think you might have done something to the Brachiallas. If it hurts (not really a pain IMO) when your in full lock and especially after release it is.

It's main role is to flex the elbow and when aggravated it can be a complete PAIN IN THE ANUS! I have experienced it several times.

I rested for a  bit (week max). Then worked on opposing muscle groups (anything that involves pushing) - I recommend downloading the Chest, Shoulders and Triceps dvd from the P90X workout. It's good cos it only lasts an hour and kicks your arse (if you try hard enough).

I may be wrong, but good luck with it dude, let us know how you get on.

[gremlin]

Thanks for the advice chaps.

Looks like rest/ice/physio is the key.

What's the score with Ibuprofen? Is it beneficial (reduces swelling) or a hindrance (masks the pain so everything seems OK)?

[mrjonathanr]

It's a Non Steroidal Anti Inflammatory. Reduces inflammation = good. Reduces pain = bad if you intend to climb directly after taking it. Voltarol is moe powerful than Ibuprofen but tablets are prescription only in this country. I have my doubts about the cream you can get in the supermarket, but it's worth a punt. Ice is king tho, just remember  it makes tissues fragile till warm again.

[GCW]

Voltarol (diclofenac) has not been shown to be much better than ibuprofen with regards to anti-inflammatory action, and its side effect profile is much worse.  I personally wouldn't use it.

For what it's worth, NICE recommend topical ibuprofen as a first line (ie before oral) for certain types of arthritis, so there's some evidence base for efficacy.

[mrjonathanr]

Oh. Well you're the doctor... my info comes from physio advice over the years so is assumed to be correct rather than proven. They are pretty similar drugs at the end of the day. What's the beef with diclofenac and side effects (beyond stomach issues)? I'm still sceptical re. topical application as I find it hard to believe much of the drug will get through tissues to where you need it most, but like I said, I'm no doctor.
I still believe in ice though- in fact I suspect it's more effective than most drug treatments, but impractical to apply at work whereas you can just pop a pill and hope the inflammation is subsiding.

[webbo]

. Voltarol is moe powerful than Ibuprofen but tablets are prescription only in this country.

you have been able to buy it over the counter in smallish doses for some time.

[webbo]

Voltarol (diclofenac) has not been shown to be much better than ibuprofen with regards to anti-inflammatory action, and its side effect profile is much worse.  I personally wouldn't use it.

For what it's worth, NICE recommend topical ibuprofen as a first line (ie before oral) for certain types of arthritis, so there's some evidence base for efficacy.

is there some new reasearch on this as i had been led to belive that NSAIDs were not that effective in topical form.indeed the bnf says oral preperations are effective in relieving musculoskeletal pain but topical may provide some slight relief.

[stevej]

Voltarol (diclofenac) has not been shown to be much better than ibuprofen with regards to anti-inflammatory action, and its side effect profile is much worse.  I personally wouldn't use it.

For what it's worth, NICE recommend topical ibuprofen as a first line (ie before oral) for certain types of arthritis, so there's some evidence base for efficacy.

Really? I know your credentials are actually er, credentials, whereas I'm just a dick with a bad knee but I've found diclofenac reduces inflammation in my occasionally horribly inflamed ITB far more effectively than any sized dose of ibuprofen, which for the amount of good it does might as well be a handful of skittles. A normal over-the-counter 25mg dose stops and relieves the inflammation if I take it as soon as I notice it and a 100 mg terminal bone cancer patient -sized dose* temporarily relieves my knee if it's been allowed to keep on getting worse to the point that it's truly fucked and won't bend. I really should see someone about that.

The only time topical anything has had any affect on me was when I got deep heat in my eye.


*you know how it is with people giving you left over pills, I had a google afterwards and probably won't do that again...

[tobym]

Voltarol (diclofenac) has not been shown to be much better than ibuprofen with regards to anti-inflammatory action, and its side effect profile is much worse.  I personally wouldn't use it.

For what it's worth, NICE recommend topical ibuprofen as a first line (ie before oral) for certain types of arthritis, so there's some evidence base for efficacy.

is there some new reasearch on this as i had been led to belive that NSAIDs were not that effective in topical form.indeed the bnf says oral preperations are effective in relieving musculoskeletal pain but topical may provide some slight relief.

Kind of, it's been a complete turnaround in the advice that we've been told to give patients, mainly in the light of all of the recent evidence about the risks associated with oral NSAIDs/Cox2 inhibitors, and, I think it is more a case that

 topical NSAIDS do little harm,  ???
Diclofenac has been assocciated with a higher incidence of cardiovascular risk,(on a personal note, I get more GI effects with ibuprofen, than diclofenac!)

[mrjonathanr]

you have been able to buy it over the counter in smallish doses for some time.

Really? I didn't know. I can tell you that (directly sourced, non-internet) 28 x 50mg Serbian tablets weigh in at a mighty £1 a time. Will have to ask pharmacist friends about UK costs.

[mrjonathanr]

Kind of, it's been a complete turnaround in the advice that we've been told to give patients, mainly in the light of all of the recent evidence about the risks associated with oral NSAIDs/Cox2 inhibitors,..................Diclofenac has been assocciated with a higher incidence of cardiovascular risk

 Is aspirin implicated in this too?

[stevej]

Pack of not very many (12?) 12.5 mg voltarol tabs costs a ridiculous £6.50ish

[mrjonathanr]

Wow. That about £60 in UK prices for a pack that'll cost £1 in Belgrade. I hope my mate's wife keeps on visiting her relatives on a regular basis.


# must check sums better

[tobym]

Is aspirin implicated in this too?

As far as I am aware, cardiovascular risk*; No, GI risk (especially at anti-inflamm. doses) yes.

Aspirin is priscribed regularly as prophylaxis in those with history of MI/CVA, but risk outweighs benefit in most other patients. I certainly wouldn't recommend its use as an anti-inflammatory for musculoskeletal use!

[GCW]

Naproxen is probably the NSAID of choice because of equivalent anti-inflammatory action to diclofenac, with lower side effects.  We've know for years that NSAIDs strip your gut lining and fuck your kidneys, but the increased risk of MI is a more recent finding.  It was thought that it was just COX2s but it appears to be a class effect.

Nowadays I tend to suggest ibuprofen OTC or prescribe naproxen, for as short a duration as possible.

[duncan]

NSAIDs have no proven long-term benefit in soft-tissue injuries and may interfere with the healing process (Paolini and Orchard 2005).  They have well-proven side-effects. "We do not recommend their use for muscle injuries, bone fractures (also stress fractures) or chronic tendinopathy" (Ziltener et al 2010). 

Ice, paracetamol if the pain bothers you, and address the underlying causes which may be shoulder or muscle-imbalance related.

[GCW]

"We do not recommend their use for muscle injuries, bone fractures (also stress fractures) or chronic tendinopathy" (Ziltener et al 2010). 

There's reasonable evidence to suggest NSAIDs impair bone healing, I certainly didn't use them in acute bony injuries (I'd always bash/drill things instead).

The above statement is a bit sweeping, I think there is a role for NSAIDs but you need to be aware of when to use them.  This makes more sense to me:

In all cases, if chosen, NSAID treatments should always be kept as short as possible and should take into account the specific type of injury, the level of dysfunction and pain.

[mrjonathanr]

I get the bit about inhibiting healing processes but surely for subsequent established inflammation NSAIDshave a role? Incidentally Naproxen seems to be the only analgesic you can buy in Norway but doesn't seem to be available here.
 btw does MI = Myocardial Infarction (or Clutcher, to use the medical term) ??

[The Sausage]

Did a quick search on the forum (for bicep) but nothing seemed to match my symptoms.
Ta.

You have probably strained the brachioradialis - its a common climbing injury.

Sorry, haven't got anything to contribute apart from...
a) it won't be brachioradialis (it's on the outside of the arm)
b) brachioradialis strain isn't a common climbing injury

My only advice is to be careful when heeding advice gleaned from climbing forums