My Experience with Medial Epicondylitis
For anyone who has ever experienced tendon pain caused by climbing they know the feeling: the trademark dull ache that raises eyebrows and worsens without intervention. I have experienced the many ups and downs of medial epicondylitis (AKA golfer’s elbow).
The first piece of advice I can give is: be patient. Look online and educate yourself. Many health practitioners are eager to call the condition tendonitis. They will tell you to ice it, rest, take anti-inflammatory meds , and send you packing. The truth is you probably don’t have inflammation in your elbow. Therefore, you don’t have tendonitis. If you have a burning fire like sensation in the joint then you many have tendonitis, and what is mentioned above is good advice. If you have a persistent dull ache while warming up, during, or after climbing then you more than likely have a form of tendonosis.
Whether your ache is on the inside or the outside of the elbow makes a difference of what exercises to perform. If your pain is on the inner part of the elbow with your palm up then you have golfer’s elbow, and this is most commonly seen in climbers. If your pain is on the outside of the elbow (tennis elbow) this can be irritated by climbing, but probably it is not the cause. The cause may be manual labor, or working on the computer long hours. From here on out I will focus on golfer’s elbow because that seems to be the most common problem for climbers.
The root cause of tendonosis is debatable. Imagine that every time you climb your tendon gets stressed and micro-tears. This phenomenon is much like soreness in muscles, but the tendon is a slow healer. Once a tendon is torn it forms patchy and mangled repairs much like scar tissue. Unlike scar tissue this repair is not strong and it will tear again during further climbing making the ache return. Also, the forearm muscles are strengthened and adapting to climbing much faster than the common flexor tendon. The muscles get strong and pull on the tendon that has not caught up strength wise. If ignored the condition worsens and makes climbing not pleasurable.
So you have tendonisis and you want to reverse it?
Eccentric exercise is the phase of movement in which the muscle lengthens. In a bicep curl the eccentric phase the part of the exercise where the weight is being lowered (the bicep is lengthening). Eccentric wrist curls and eccentric pronation are the exercises of choice to aide your tendonosis.
See this article for the most comprehensive breakdown of the exercise protocol:
The angled position, volume (number of reps), and intensity (weight) is a trial and error dilemma. I have found personal success with high volume, and moderate intensity.
3 sets 15 reps (2x per day morning and night every day)
Some people find success in 3 sets 8 reps (2x per day morning and night every other day) as mentioned in the article.
What I will advise is to get an adjustable weight set. You will want this to help you hone in on the amount of weight needed for both exercises. You want to feel some pain while performing these exercises. Contrary to most other situations let pain be your guide. Make it hurt, but not to a miserable extent.
You will be sore after doing this and your ache may ramp up for up to 4 weeks. If your elbow feels miserable adjust the volume and or intensity accordingly.
Perform basic forearm stretches daily. Be sure to stretch your forearms right after climbing while your muscles and tendons are very warm. Doing so will gain flexibility and make everything less tight.
See this article for a few stretches:
I like to stretch multiple times a day for 35-45 seconds. After climbing hold longer for a thorough stretch.
Proper Warm Up:
Hopping on easy problems or routes, in my opinion, is not a proper warm up. Do a dynamic warm up that target the muscles you will work climbing. The best one I have come across is:
The warm up above is efficient quick and very useful. Warm ups aren’t fun, but they are necessary. You won’t look like a hot shot doing them but it will keep you less prone to injury.
Much of what I have read about climber’s elbow recommends rest and eccentric exercises. A revolutionary idea to me was active recovery. Dave Macleod touches on this a lot in his book Make or Break: Don’t Let Climbing Injuries Dictate Your Success. This is the only book I have ever seen in particular relation to climbing injuries. Before reading this book, which I recommend 100 percent, I took 2 months off of climbing and performed only eccentric exercises for my forearms. This time was absolutely miserable. Not climbing is awful for you and anyone who sees you miserable daily. I didn’t do any upper body workouts. Not doing so hurt me mentally, and later I found out physically.
You can and should do very light climbing in conjunction with an eccentric/stretching program. You do not want to have weakness in the tendons and muscles. Once you get back into climbing after a break the chances of injury are higher due to eagerness to get back to the level you climbed at before. Also light climbing brings blood flow to the injury and helps facilitate healing.
Light climbing is not pushing your limits. You have to go into a light climbing session with the idea that you are trying to heal, not crush. This is very hard to do. Very ,very hard to do if you push yourself like most climbers. If there is pain, stop. Cut back significantly on the amount of time in the gym, and the grade you are climbing. Otherwise, you will cause further damage and you will be worse off for a longer period of time.
Read Dave Macleod’s book. Seriously:
It costs a pretty penny. But I overnighted it to myself one day while very frustrated and upset. It costed me, but I do not regret that decision one bit. I go back to the book all the time, and it has helped me through many emotional setbacks from injury.
Other Things I Have Tried:
- Theraband Flexbar: I have the strongest one (blue). It isn’t enough to work my tendons. I know use it as a warm up before climbing.
- Elbow Revive Supplement: This product contains cissus quadrangularis. Many body builders and climbers recommend it. Does it work? Maybe. I’ve use it and it doesn’t hurt to try. I have seen results in recovery time. Who knows, it could be placebo effect. But the cost has significantly raised on this product. Consequently I stopped using it.
Take Away Message:
You need patience. This is a chronic condition, and it will probably re-occur. Am I fully recovered? Sometimes… Once I ramp up my climbing volume or intensity I have small bouts of tendonosis ache. The cure I have found is increasing the eccentric exercises. When I have no pain I do them every other day in the morning and at night except on training days. When I have pain I do them daily and the ache surprisingly subsides. The only true cure in your condition is going to come from patience and customization of a plan. The truth hurts in this case, but accept your condition and strengthen yourself out of it.
-James Verhague (B.S. Kinesiology, CSUF)