Climbing to the top of your health: Elbow Talk

By Susan Leung, PT

Rock Climbing Injuries

Rock climbing has gained immense popularity over the past few decades. Last year, it was announced that rock climbing will be featured as a new Olympic sport in the upcoming Tokyo 2020 Olympic Games. This is an exciting time for both novice and expert climbers alike! But with every sport, there are risks. The most common injuries sustained in this sport include those affecting the shoulder, elbow and fingers. Studies have shown that more experienced climbers who are attempting harder routes and problems are more likely to develop injuries (Jones & Asghar & Llewellyn, 2008). That said, it is important to know when to keep climbing, and when to close that chalk bag to call it a day.

 

Rock Climbing Mistakes that lead to Injury

Can you recall how you felt a day or two following your first climbing experience? If you were like me, you would’ve felt as if your entire upper body had been run over by a massive truck (especially around the forearms). Most of us start off by “muscling it up the wall” using our biceps, constantly pulling in with our elbows when we should really be using more of our legs to push and ascend the walls. Overgripping is something that happens to all of us newbies. By gripping each hold for our dear lives, it gives us a false sense of security that if our foot were to slip, perhaps our arms would allow us to stay on the wall. However, not all of us have Spiderman’s genes, and the repetitive overgripping may later develop into an overuse injury that may prevent us from becoming better climbers. Depending on the type of hold that is present on the wall, you may want to try hanging your fingers and palms off it to decrease the amount of stress applied to your forearms, wrists, finger joints and tendons.

 

Rock Climbing and Elbow Pain

With all the repetitive gripping that is inherent to the sport, many rock climbers may develop what we call medial epicondylitis or medial epicondylosis (otherwise known as golfer’s elbow). Both conditions will cause pain along the inner part of the elbow and forearm. This is often noticed with gripping activities or lifting objects in a palm up position. These two conditions may sound quite similar, but will differ greatly in the way that they are managed therapeutically.

Medial Epicondylitis

Medial epicondylitis is an inflammatory condition whereby “itis” stands for inflammation in Latin. It affects the inside aspect of the elbow, where the muscles that are mainly responsible for gripping, transition to become a tendon (a rope-like structure). The tendon will eventually attach onto the medial epicondyle, which is a point on the arm bone. Since the actual tendon is actively inflamed, modalities and NSAIDs may be appropriate for use. A systematic review done by Hoogvlet et al. in 2013 found stretching and strengthening to be effective short-term relief (Hoogvliet & Randsdorp & Dingemanse & Koes & Huisstede, 2013).

Clinical treatment may include the use of ultrasound and acupuncture but should also focus on factors contributing to the injury including workspace ergonomics and muscle imbalances.

How this may affect your climbing

Early return to sport may:

• prolong the inflammatory phase of healing to cause increased warmth, swelling, and point tenderness
• hinder your ability to grip holds, and increase activation of your neck and shoulder musculature to compensate
• initiate pain either immediately during, or shortly after your first climb

Therefore, consider taking a break from climbing, and spend your time cross-training instead! Try to chose activities that won’t involve too much repetitive gripping (e.g. ease off those pull-ups and deadlifts). You may want to opt for cardiovascular exercises to improve circulation, mobility work to remain loose and limber, and try resistance band exercises to target the shoulder girdle.

 

Self Treatment of Medial Epicondylitis

Ice packs can be used on the painful region for 10 minute on-and-off intervals, for 3-4 times in total.

Stretching the wrist flexors and extensors can also be beneficial.  This can be accomplished by keeping your elbow straight, try pulling your wrist up and hold for 30 seconds. Do the reverse by pulling your wrist down, and hold for 30 seconds. Repeat this 5-6 times. Now repeat the above with your elbow slightly bent.

Strengthen your rhomboids by having your arms straight in front of you to begin. Squeeze your shoulder blades to pinch them together nice and tight, and slowly pull your hands apart. Hold this for 5 seconds, and take at least 3-5 seconds to return to the starting position. Try this for 2-3 sets of 8-10 reps, or as tolerated.

 

 

Medial Epicondylosis

With medial epicondylosis inflammation is absent. This means that non-steroidal anti-inflammatory medications (NSAIDs), and the application of ice may not be of much benefit. Symptoms may begin more than a week after climbing.  Exercises that are aimed at lengthening and loading of the common flexor tendon will be appropriate during this stage of healing, such as eccentric wrist curls. Cervical and thoracic manipulation were also found to offer both short-term and mid-term relief as an adjunct therapy when combined with wrist and forearm mobilizations (Hoogvliet et al., 2013). Clinical treatment involves modifying the aggravating activities, specific strengthening emphasizing eccentric training, scar tissue mobilization/massage and functional training. Additionally, the use of proliferative therapies such as ultrasound therapy shockwave therapy and acupuncture may be considered to progress healing.

 

How this may affect your climbing

Early return to sport may:

• cause adhesions to form around the muscle belly and/or tendon of the forearm extensors, secondary to repetitive strain
• hinder your ability to grip holds (whether they be jugs or crimps)
• initiate pain midway through your climb, near the end of your climbing session, or even the day following climbing

Therefore, consider picking routes or problems that are easier than what you normally attempt, and concentrate more on using more of your lower extremities. Traverse routes would be a great way to work on your technique and balance, without having to constantly use your maximal grip. So, stay away from dyno moves, and your body will love you for it!

 

Self Treatment of Medial Epicondylosis

Strengthening the weakened tendons is crucial to resolve your pain. Try holding a small dumbbell or a can of soup, and stabilize the forearm by resting it on top of a table. Slowly allow your wrist to drop, taking around 3-5 seconds to descend. Repeat 2-3 sets of 8-10 reps, or as tolerated. It is fine to feel a bit of pulling or discomfort around your elbow, but never pain.

Another eccentric training exercise for the forearm muscles is to use a bar with a weight. Place your hands around the handle bar, and slowly drop your wrist down using 3-5 seconds. Let the rope come completely undone, and drop the weight down on the floor to rearrange the rope back around the handle bar. Repeat 3-5 times, or as tolerated.

 

Don’t let Elbow Pain Limit You!

So, if you are currently suffering from an elbow injury (whether it be medial epicondylitis or epicondylosis), there are different treatment options and management techniques to help you feel better, stay better, and get you back to the crag with a smile on your face. Book an appointment to speak to one of our associates today!