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doctor or PT recommendation in Salt Lake valley for arm/tendonitis issues?
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By John Evans
Dec 9, 2012

I am done, done, done with my RSI/elbow issues screwing up my climbing and training. Does anyone have a recommendation for a good, climbing savy, clinician in the Wasatch area? Doctor, Physical Therapist or other, I am interested in hearing suggestions. I seem to be stuck with chronically strained brachioradialis muscles and tennis elbow pain, generally in both arms. Typing and mousing can easily make it worse if I don't watch it (use good technique and don't do too much)

I used to see Dr. Toronto, years ago, and received a decent amount of help, cortisone shots eventually, that got me out of a always inflammed loop I seemed to be stuck in (months of wrist curls and pronator/supinator exercises didn't do much). But I don't want any more cortisone shots, and I don't know if he is seeing patients anymore.

Tried massage years ago as well, before the cortisone, but it didn't help. Maybe its time to try that again.

My wife and I have a two week road trip throughout Wyoming, where I learned to climb, planned for next July, and I want to train and be ready for it, not be weak and injured.

Thoughts, suggestions, recommendations, please.


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By Jake Jones
From Richmond, VA
Dec 12, 2012
Me and the offspring walking back to the car after a day of cragging.

Your injury sounds like tendinosis, a recurring degenerative condition, as opposed to tendinitis which is usually the initial injury or inflammation of the tendon.

Most people don't like to hear this, but usually when things are this far gone, a generous amount of rest is needed. Massage, like other PT remedies is only effective if you do it constantly- multiple times per day. I had tendinosis really bad on the medial side of my right arm and I think I took about 8 weeks off. After two weeks of complete rest, I started PT exercises and rigorous massaging and stretching.

I before each exercise session, I would stretch thoroughly, almost to the point of pain. For outer elbow maladies, pronation exercises work best. My best results came from using a one sided dumbbell starting with a single 5lb plate. For pronation, start from vertical, and rotate to palm down position 90 degrees. Assist the weight back up to vertical WITHOUT using the arm you are working on. Do three sets of twenty with a few minutes of rest between each set. Experiment with different angles of your elbow to try to acheive the angle that agitates the affected area MOST. If the pain starts to reach the 7-8 range on the ten scale, either stop and rest more, or decrease the weight/number of reps until it is manageable.

I started with three sets and one session per day, and as I progressed, I was doing six sets and two sessions per day adding weight so that I could barely do three sets of twenty struggling, but not sacrificing form.

Massaging follows sort of the same principle. If you can feel the affected area and it is painful with pressure, start there. Deep massaging should not be comfortable. The more you dig in (a fine line there, do not apply so much pressure that you could bruise or injure something), the more bloodflow will be promoted- this is the main purpose of massaging. Tendons aren't like muscles, there is very little bloodflow and that makes healing a much slower process. Anything you can do to promote more bloodflow will help.

Stretch before every exercise session and massage at least three times a day with several hours in between massaging. Throw away your NSAIDS- they don't help with recurring degenerative conditions that you're experiencing, and some studies show they actually inhibit healing in these types of cases.

It is likely that you have heard all this before, or you may have even tried a similar program without success. If not, this is certainly worth a try. It worked wonders for me, but diligence really is the key to success. Bad elbows suck, and it really can demoralize you if you don't get a handle on it. I wish you the best of luck. I hope this helps.


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By Tico
Dec 12, 2012

Emma Maaranen (focusbodywork.com) is good at this sort of thing, and actually helped me with issues Dr. Toronto couldn't. She works with a lot climbers. Good luck.


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By John Evans
Dec 15, 2012

Well, thanks for the ideas and references. I have an appointment with Emma in early January. I'll definitely be creating a set of PT exercises to use, probably after seeing Emma, and see if she recommends a particular doc, or PT person. Rest doesn't worry me too much as I have been doing that for a while already. I am ready for it to end though so I can be training. Still, top concern is to be pain free and be able to just get out and trad climb regularly in the Spring and Summer.

Jake, the idea of targeting the eccentric exercises to the areas where the pain is the most is new to me, but I have seen it on Julian Saunders website as well (www.drjuliansaunders.com), though for different motions. I will be setting up a routine with your suggests and some of his and working gently, but painfully through those in the next several weeks and longer, I'm sure.

With respect to massage, I'm assuming this is self massage with the opposite arm? Both arms are an issue for me, and I don't want the massage to be a stressor for the arm doing the massaging. Any opinions about the Forearm Rx device for massaging? (www.forearmpain.com) I'm not sure if it would be focused enough.

Thanks for everyone's comments and thoughts.


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By tenesmus
Dec 18, 2012

John,
I've had a ton of issues with pain there too. Two things help a bunch:
To stretch your right brachioradialis, cross your forearms placing your palms together, pinkies out. Use your left hand to twist your wrist counterclockwise. Keep your elbow straight. Extend your left wrist to stretch your right. I said keep your elbow straight.
Do the same on the other side.

The other thing is a Bikram yoga position that I thought was going to break me. When you're warmed up, lie on your stomach. Place your arms under you, palms down and pinkies together, head forward. The weight of your body will force your elbows into extension. This hurts kind of like a mo-fo. Take it easy and be careful you don't injure yourself. If you can lift your legs up off the floor it increases the tension but be careful with it. When I do this one consistently I have absolutely no elbow pain but you gotta start slow and be very careful.


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