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tokyofixedgear
May 2, 2008, 4:26 PM
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Hey,
I started climbing again after two years of nothing about 3 weeks ago. I'v been bouldering. On the second week I hit the gym every day trying to complete a problem. I did complete the problem but under enourmous pain. I started feeling an enormous dull pain round the inside of the elbow. I feel fine for the first 30mins but after climbing becomes almost unbearable. I feel the pain less when actually climbing but its terrible for the next 5 minutes after, then painful for the next hour. Im in japan so its a little tricky to see a docter but Im thinking it could possibly be climbers elbow. What can I do to get climving again??? cheers!
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phoenicks42
May 2, 2008, 4:42 PM
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An overuse injury. Tendonitis. Rest, ice and climb, if at all, below your level. An arm band that restricts movement of tendons around the elbow is also helpful. Sometimes taping your ring finger/mid finger will also take pressure off of the area.
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angry
May 2, 2008, 4:45 PM
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It sounds like you did too much too soon.
Almost certainly you have tendonitus (acute) or tenodonosis (chronic). The more medical types can chime in to which it is.
Based on the short time frame involved, it sounds acute. There's not really anything you can do but rest up and let it heal. Stretching and opposing exercises keeps the chronic pain at bay.
Time off or slab climbing.
Sorry.
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tokyofixedgear
May 2, 2008, 5:21 PM
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As the pain isnt constant how do I know when Im all healed up?
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angry
May 2, 2008, 5:28 PM
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It's a dull throbbing on the inside of the elbow that is worse in the morning and after a climb but doesn't bother you when you're warmed up and climbing right?
You won't know when you're healed up but you can always self assess as to how it's feeling and go from there.
Try to be a multidimensional climber too, just bouldering is bad. Too powerful and too repetetive.
One other thing, based entirely on your user name. When I was in the habit of spending lots and lots of time on a road bike, I also got elbow tendonitus just like climbing causes. Check the fit of your bike, change hand posistions, don't spend all day riding on your brake hoods.
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AnthonyATX
May 2, 2008, 6:21 PM
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I had a similar problem, and it was indeed overuse. But the underlying problem was that I wasn't working my antagonist muscles, so the muscles used for climbing were sort of overpowering the non-climbing muscles. It was the dull pain you described, on the inside elbow right below the bicep.
One thing I found that helped a lot was pushups. About 5 sets of 10 every night or so should help build up the muscles that get ignored while climbing.
Your mileage may vary though, as I didn't get the elbow pain until 6 months of climbing, but I wasn't bouldering the hard stuff either.
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onceahardman
May 2, 2008, 6:42 PM
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All of the finger and wrist flexors originate from a common tendon at the medial elbow (Common Flexor Tendon). Most commonly, what happens with such a rapid onset is either a partial tear of this tendon, a partial avulsion of it from the medial epicondyle (bony attachment), or general inflammation of the tendon, without any tearing.
Common treatment includes rest, ice, stretching, and strengthening of wrist and finger extensors.
(Reverse wrist curls)
Another muscle called pronator teres also originates at the common flexor tendon, and was the cause of my own case of "medial epicondylitis". Pain with resisted pronation (turning your hand from palm up to palm down) can assist your own assessment, but if the whole tendon is inflamed, then all resistive tests will provoke pain.
In my own case, a spasm reduction technique, self-administered, relieved my pain completely within a week.
It won't get better by "training through the pain". You can climb easier stuff, or footworky, slabby stuff, as long as you aren't provoking the symptoms.
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tokyofixedgear
May 2, 2008, 6:50 PM
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AnthonyATX wrote: I had a similar problem, and it was indeed overuse. But the underlying problem was that I wasn't working my antagonist muscles, so the muscles used for climbing were sort of overpowering the non-climbing muscles. It was the dull pain you described, on the inside elbow right below the bicep. One thing I found that helped a lot was pushups. About 5 sets of 10 every night or so should help build up the muscles that get ignored while climbing. Your mileage may vary though, as I didn't get the elbow pain until 6 months of climbing, but I wasn't bouldering the hard stuff either.
How long did you rest it for? I heard cod liver oil really helps?! No the less Im popping them like mad!
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AnthonyATX
May 2, 2008, 6:55 PM
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When my arm had started hurting, I had climbed for 7 days with twos day rest (I think it was 3 days, 2 days rest, 4 days)..
It was the last 2 days that the arm really was bothering me.. so I rested just a few days, and did pushups and core exercises (and advil).. I went back to the gym to see how bad it would be, and surprisingly, everything felt fine.
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angry
May 2, 2008, 7:06 PM
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not to plug anyone's website here but
http://www.julstro.com
Nothing revolutionary here, simple myofacial release but in a format my dumb ass can follow.
Email Julie if her books don't help, she is extremely helpful.
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jdefazio
May 2, 2008, 7:32 PM
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angry wrote: One other thing, based entirely on your user name. When I was in the habit of spending lots and lots of time on a road bike, I also got elbow tendonitus just like climbing causes. Check the fit of your bike, change hand posistions, don't spend all day riding on your brake hoods.
Note his userneame has "fixedgear", so no brake hoods for this guy. Unless he has one of those oh so useful under-saddle or top-tube mounted brake levers. Either way, fixies are much too busy to worry about bike fit and positioning, what with all the time it takes to "fight the system" and everything.
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michal104
May 2, 2008, 8:46 PM
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You're climbing too much before your body is ready for it. Powerful bouldering requires a lot of rest and shouldn't be done more than 3 times a week, and even that is a lot. Since you asked this question so soon after the onset of your elbow pain, hopefully this is just an acute inflammation and will go away after a week of rest and icing a few times a day. After you do that, start climbing again, but lightly, and take a few weeks to build back to normal difficulty level and sufficient volume. Check out this article for all you need to know on exercises that heal elbow tendonosis (chronic climber's elbow). I've had horrible elbow pain in both elbows and these exercises fixed it within 6 weeks both times around. I still do them preventively about twice a week.
www.athlon.com.au/articles/r&i_dodgyelbow.pdf
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stonefoxgirl
May 4, 2008, 5:07 PM
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Unfortunately sounds like you are looking for the quick solution. With this type of injury, or onset of something which could become more painful you might consider going about climbing differently. Get back into climbing in a way that mentally and physically matches. My last day on the rock was Aug07 due to school. In one more week I'll be getting back into it again. The last place I would head to is the bouldering cave, you are asking for an injury. My suggestion may seem boring but it's great conditioning to get back into the vertical world. Go to your gym or wherever you climb and do laps on the wall in a traversing manner. Not only will it start working your arms and grip strength but your footwork will improve too. I do this for a week before I ever touch a route on the wall. It lets me know where I stand and what type of training I should do to climb outside injury free. I have had epicondylitis in both of my elbows and it's painful. I quit climbing for a year. I came back, hit the bouldering wall and 'pop' there goes the finger and another 6 months out. Maybe Im too careful now but I'll tell you that I went about coming back last summer in a way that got me climbing my personal best and injury free. Take it easy, take the time to heal and don't be stubborn. Good Luck.
PS - if you OD on any fish oil you are going to smell really bad, Im not kidding (Im laughing right now but Im serious, ewwww)
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mrswix
May 5, 2008, 4:56 AM
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Lateral Epicondylitis
"tennis elbow"
an inflammation of the tendons on either sides of your elbow.
i suffer from it as well. it may only be one side, no difference really. rest for at least a couple weeks until the pain is completely gone. take a simple OTC anti-inflammatory such as Ibuprofen once a day and ice it if it hurts. once the pain is completely gone, wait five more days, then go climb. start very slow, and at a lower grade than you would normally climb.
MOST IMPORTANT: now that the pain (should be) gone, STRETCH AND WARM UP for at least 10 minutes before you climb.
This worked very well for me and I'm good to go once again. I am fairly young though, 20. I'm not sure how old you are, and that is a factor to consider. Worse comes to worse, talk to some veterans at your gym or see a doctor.
GOOD LUCK! : )
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brachialis
May 5, 2008, 5:44 AM
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This sounds like acute tendonitis of the bicep tendon. I get this from time to time myself. Actually, it put me out from climbing last week, but is better now. Before last week it hadn't been a problem in a good two years.
What typically works for me? Stretching prior to climbing is absolutely key. A lot of people don't realise you can stretch the arm flexors and associated tendons, but it's actually pretty simple. Place your palm against a surface (like a corner) such that your arm is horizontal. Then twist your body. When you do this, focus on stretching the upper arm and not the chest.
But for the time being, seriously take a rest. To nurse my elbow back to health I rested and used some ice. As it began to improve, I began lifting light dumbbells. I've since done some pull ups without inducing inflammation, and I'll resume climbing tomorrow.
For soft tissue damage to the fingers, I saw a film clip in which Dave MacLeod talks of cold water treatment (immersing the fingers in cold - but not ice cold - water). After about 10 - 15 minutes in the cold water, the blood vessels begin to expand, and the increased blood flow aids healing. I haven't tried this for anything but fingers, as immersing my elbow in cold water for 30 minutes doesn't sound like fun ; )
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aerili
May 5, 2008, 7:43 AM
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brachialis wrote: For soft tissue damage to the fingers, I saw a film clip in which Dave MacLeod talks of cold water treatment (immersing the fingers in cold - but not ice cold - water). After about 10 - 15 minutes in the cold water, the blood vessels begin to expand, and the increased blood flow aids healing.
It's basically an ice bath you're talking about. But cold treatments don't increase blood flow, they decrease it. This aids in healing by slowing down tissue degradation wrought by your immune cells (too much starts to kill healthy tissue, not just dead, injured tissue), as well as reducing pain and inflammation, which helps break something called the ischemic cycle. (You can look that last term up if you want to know the details bad enough.) 
In reply to: I haven't tried this for anything but fingers, as immersing my elbow in cold water for 30 minutes doesn't sound like fun ; )
You would do best to slap an ice pack on your elbow vs submerge in ice bath. Much easier to do and the most common form of cold application. Ice baths/cold whirlpool treatments are typically used mainly for injuries in the hands, feet, or lower leg but rarely other body parts.
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Nick864
May 5, 2008, 7:59 AM
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aerili wrote: It's basically an ice bath you're talking about. But cold treatments don't increase blood flow, they decrease it. This aids in healing by slowing down tissue degradation wrought by your immune cells (too much starts to kill healthy tissue, not just dead, injured tissue), as well as reducing pain and inflammation, which helps break something called the ischemic cycle. (You can look that last term up if you want to know the details bad enough.)
Actually if you look at MacLoed's website, it explains another method other than the traditional "Ice Bath" He talks about immersion in cool water for slightly longer than normal icing. The method is supposed to stimulate your body to increase blood flow somehow. I do not know the details and I have absolutely no medical training. However this method did work wonders for my elbow pain. If anyone can explain this in layman's terms id be very interested.
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aerili
May 5, 2008, 8:20 AM
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Well, during actual cold application, vasoCONSTRICTION occurs (reduced blood flow), as well as a slow down in velocity of nerve conduction (i.e. slower pain signals).
However, if you have swelling present, blood flow may already be reduced since the swelling can block blood flow to the injury. Also, chemicals released by the dying/damaged cells signal such inflammation and swelling to occur...so if their healthy neighbors can't get normal blood flow, they start to die as well from lack of O2 (and possibly other stuff, like cellular membrane disruption or something from these enzymes, but I don't know much about that aspect). So it's possible icing is slowing down the healthy cells' metabolism, allowing them to survive longer and with less damage until normal blood flow returns again (kind of like when you fall into a frozen lake but may not suffer as much brain damage as one normally would from similar O2 deprivation).
Blood flow ultimately may be increased in the long run, but this usually happens post-icing. Mainly b/c swelling and inflammation were reduced, allowing occluded vessels to function normally again in the area (and maybe this is what brachialis was talking about but rather indirectly).
If you have no swelling present with your elbow pain (probably a chronic injury?), I would say your pain was greatly helped by Macleod's method mainly b/c cold reduces pain signal transmission.
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brachialis
May 5, 2008, 5:35 PM
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(http://onlineclimbingcoach.blogspot.com/2007/06/finger-injury-treatment-videocast.html)
Besides being an elite climber, Dave has a masters in sport science, and I've read about this effect elsewhere.
And regarding its use for elbow tendon injury (http://onlineclimbingcoach.blogspot.com/search/label/Injuries)
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aerili
May 5, 2008, 9:05 PM
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Hi brachialis,
I actually have a degree in this area as well, including a fair amount of experience administering ice treatments on patients with a variety of sports med injuries.
I didn't watch your video (don't have time, plus I like people who make their links clickable to begin with b/c I am a very lazy person, heheh), but I did notice that Dave mentions no scientific evidence exists for his modified guidelines.
However, I don't dispute ice can make people feel better or even speed up the recovery process for some (if you read my reply to Nick above it goes into detail about how blood flow may increase later on, but not during the actual icing). I'm also not saying that you can't dunk whatever body part you want into a cold immersion (heck, runners think putting their whole bodies into ice is somehow good for them); hands/feet/lower legs are usually the only things iced this way by healthcare professionals simply because it's hard to ice them with a pack sometimes. Hence why I recommended trying an ice pack on your elbow if you don't want the mess etc. of a cold immersion. Dave seems to have zero scientific evidence an ice pack doesn't work as well as his particular form of ice bath.
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brachialis
May 5, 2008, 11:04 PM
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In reply to: Dave seems to have zero scientific evidence an ice pack doesn't work as well as his particular form of ice bath.
Eh, watch the video, then. Here's a clickable link: http://onlineclimbingcoach.blogspot.com/...tment-videocast.html
You don't need to watch all of it, just the beginning, where he discusses the theory and when in the healing process to apply this treatment. What's key to understand is that the treatment is not an ice bath, that the water is cold but not icy cold.
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onceahardman
May 6, 2008, 5:43 PM
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Hey...I think you guys are talking about the "Hunter's Response"...
It gets mis-used sometimes, as it's really a cutaneous phenomenon, it really doesn't increase "deep" blood flow...but it DOES make your hands turn red, and feel warm.
http://www.accessmedicine.com/content.aspx?aID=604325
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brachialis
May 18, 2008, 5:41 AM
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These lecture notes http://www.mtsu.edu/...hi/atep/497/ch4.html I found through a Google search claim that the ensuing vasodilation still falls short of the baseline level. If this is true, then Dave's treatment is not likely useful, unless the fingers are an exceptional area.
But assuming this lecture note isn't correct (or the exception is the case), as regards the coetaneous/ sub-coetaneous variable, Dave only suggests using the treatment for the fingers (its success in other areas, like the elbow, is only backed by anecdotal evidence, he mentions) And since there are not muscles in the fingers, do blood vessels in the fingers run appreciably far beneath the skin?
(This post was edited by brachialis on May 18, 2008, 7:05 AM)
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onceahardman
May 18, 2008, 1:17 PM
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Hi brachialis...
I'm not going to refer to any textbooks, but just from memory. Application of external heat only warms about 1/4 inch deep or so. after that, the heat is quickly and efficiently carried away by the rich supply of subcutaneous blood. Externally applied cold goes a little deeper, as I recall, but still, only 3/8 inch or so. Modalities like ultrasound and shortwave diathermy send heat deeper.
Do you know what increases DEEP bloodflow? EXERCISE! even active range of motion (AROM).
And yes, there is deep bloodflow in the fingers, bone has a rich blood supply. Articular cartilage gets nutrients through the flow of synovial fluid, made by the synovium. This also has blood supply.
AROM, as I've said many times, is highly under-rated as an exercise, especially in rehabilitation of injury.
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stymingersfink
Jun 1, 2008, 7:11 PM
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tokyofixedgear wrote: Hey, I started climbing again after two years of nothing about 3 weeks ago. I'v been bouldering. On the second week I hit the gym every day trying to complete a problem. I did complete the problem but under enourmous pain. I started feeling an enormous dull pain round the inside of the elbow. I feel fine for the first 30mins but after climbing becomes almost unbearable. I feel the pain less when actually climbing but its terrible for the next 5 minutes after, then painful for the next hour. Im in japan so its a little tricky to see a docter but Im thinking it could possibly be climbers elbow. What can I do to get climving again??? cheers!
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