Elbows

DIAGNOSIS

  • Lateral Epicondylitis or “tennis elbow”- Your pain occurs on the “outside” of the elbow and often happens while grasping objects, even something as trivial as a beer bottle. You also may experience pain while turning doorknobs. For treatment see section below.
  • Medial Epicondylitis- This is similar to Lateral epicondylitis, but it is on the “inside” aspect of your elbow. For treatment see the section below, however the upper forearm strap does not generally help.
  • Deep elbow pain (brachialis tendonitis) – I have so far only seen this injury in climbers. The pain is felt deep in the front of your elbow.
  • Tricep tendonitis – This occurs in the distal attachment of the tricep tendon (right above the bony part of your elbow and on the “outside”. Tricep tendonitis rehabilitation: If you feel a pain in your triceps while working out you should stop immediately and seek medical advice.

Athletik Spesifik is a climbing specific training studio in Colorado.  They are an excellent resource for training and injury managment.  They have a comprehensive description of treatment of elbow tendentious.  

TREATMENT Reduce Inflammation - Prior to treating any tendonitis, you will need to reduce or eliminate the inflammation. Depending on the severity of the injury, take ibuprofen daily and ice massage with a Styrofoam cup for 10min (3x/day) Continue anti-inflammatory measures daily even when there is no longer pain. A general rule is 3 days beyond any noticeable pain.

Medial and Lateral Epicondylitis

  • Stretching - You can do these stretches right away, but keep out of the painful ranges. Stretching discomfort is okay, pain is bad.
    • a) Bend your wrist forward and backward as far as you can with elbow straight and arm in front of you. When stretching wrist flexion (palm towards body)- keep fingers bent. When stretching extension (palm away from body)- keep fingers straight. Hold 30 seconds in each position. Repeat 5 times.
    • b) Pronation and supination of the forearm: With your elbow bent 90° (at your side), turn your palm upward and hold for 30 seconds. Slowly turn your palm downward and hold for 30 seconds. Make sure you keep your elbow at your side and bent 90° throughout this exercise. Repeat 5 times. When these stretches are not painful, you can begin these strengthening exercises:
  • Strengthening 
    • a) Reverse wrist curls: Hold a soup can or small weight (2-5 lbs) in your hand with your palm facing down. Slowly bend your wrist upward. Slowly lower the weight down into the starting position. Do 3 sets of 10. If this is too easy, use more weight and progress to more weight.
    • b) Wrist radial deviation: Put you wrist in the sideways position with your thumb up. Hold a light weight (2-5 lbs) and bend your wrist up, with the thumb reaching toward the ceiling. Slowly lower to the starting position. Do not move your forearm throughout this exercise. Do 3 sets of 10.
    • c) Forearm pronation and supination: Hold a light weight (2-5lbs) in your hand and bend your elbow 90°. Slowly rotate your hand with your palm upward and then palm down. Do 3 sets of 10. Make sure to stop if any of these exercises cause you pain. Use a lighter weight or a soup can. If they hurt to do with a soup can, then it is too soon. Rest another week and try again. When you can do these exercises with at least 5 lbs without pain you can return to climbing. 
      Many people find that upper forearm straps help when they start climbing again. If you decide to use one, do so for the first 4-5 weeks and then attempt to wean yourself off of using it.

Eccentric exercises-  These are the only exercises that have been shown in studies to cure tendonitis.  The research was done on Achille’s tendons, but many climbers, including myself, have had good results with them for elbows and shoulders.

Medial epicondylitis eccentric exercises:

Start with a weight in the injured side’s hand (8-10 lbs) and the palm facing towards the ceiling.  Use the opposite hand to curl the weight up and then lower using only the involved hand.  Repeat 12-15 times.  Rest and repeat 1-2 more times.  
EXERCISES

Lateral epicondylitis eccentric exercises:

Start with a weight (8-10 lbs) in the injured side’s hand and the palm facing towards the floor.  Use the opposite hand to curl the weight up and then lower using only the involved hand.  Repeat 12-15 times.  Rest and repeat 1-2 more times. 
See also exercise videos listed on this page.
Deep elbow pain (brachialis tendonitis) 7-10 days of rest, ice massage (as described above) and strengthening the biceps by bicep curls and reverse bicep curls (with the palm pointing to the floor) after the rest period seem to alleviate the problem. It has also been suggested that traversing may irritate the brachialis, so consider limiting this. Tricep Tendonitis
  • Kneeling push-ups – kneel on the floor with your hands directly underneath your shoulder. Slowly lower yourself to the floor and back up. Once you can do 2 sets of 15 without any pain, switch to normal pushups.
  • Dumbbell kickbacks – Start with a really light weight and do sets of 20.
  • French stretch – Stand with your fingers clasped together and your hands high above your head. Stretch by reaching down behind your head and trying to touch your upper back. Keep your elbow pointing towards the front. Hold this position for 20 seconds or so. Repeat 10 times.

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