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Golfer's Elbow (Yes I did the forum search first)
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By kennoyce
From Layton, UT
Jun 11, 2013
Climbing at the Gallery in Red Rocks

Bill Shubert wrote:
I have had tendonitis ... I had fairly severe golfer's elbow...


Tendonitis isn't golfers elbow, it's tennis elbow. Golfers elbow is Tendonosis and as has been mentioned, reverse wrist curls are the cure. I've never had tendonitis, so I can't comment there.


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By Bill Shubert
Jun 11, 2013
Me on Kamakaze 5.10a (Ozone)

kennoyce wrote:
Tendonitis isn't golfers elbow, it's tennis elbow. Golfers elbow is Tendonosis and as has been mentioned, reverse wrist curls are the cure. I've never had tendonitis, so I can't comment there.

From national library of medicine: "Tendinitis is inflammation, irritation, and swelling of a tendon, which is the fibrous structure that joins muscle to bone. In many cases, tendinosis (tendon degeneration) is also present." They usually go together. Although you are right, when I looked up golfer's elbow, I see that the tendon involved is not part of the brachioradialis. So I had a different elbow+tendon issue.


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By Jeff G.
From Fort Collins
Jun 11, 2013
Nearing the end of Thank God Ledge.

Golfers Elbow is medically known as Medial Epicondylitis and involves the wrist and finger flexor muscles and pronator teres.

Tennis Elbow is Lateral Epicondylitis and involves the wrist and finger extensors and brachioradialis.

Both can be inflammatory = Tendonitis
Or they can be non-inflammatory and in the chronic stage = Tendonosis


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By John Johnson
From Boulder, CO
Jun 11, 2013

Here's a more permanent link to the Rock and Ice article by Dr. Julian Sanders. Thanks to Dr. Sanders for making this article available on his website:

www.drjuliansaunders.com/resources/feature_articles/dodgy_el>>>


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By Charles Vernon
From Tucson, AZ
Jun 11, 2013

Bill Shubert, I am confused, you say you had this for three years and never stopped climbing, but your profile says you started climbing in 2012.


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By Bill Czajkowski
From Albuquerque, NM
Jun 11, 2013
Triple Jeopardy starting from 1/3 of the way up.  No good pro except at this stance and after the upcoming slab.

My experience, having had mild tendonitis (golfer's elbow) at least twice before, and fairly prolonged tennis elbow for about 10 months pretty recently, is that not climbing isn't a long term fix for the problem. Every time I start climbing again it comes back immediately with no real reduction in severity.

What seems to work is dialing down my intensity (for me, no bouldering - stick to moderate difficulty routes), warm up slowly and thoroughly, and with this most recent bout - I started stretching, eccentric contractions, massage, and use of a compression sleeve for the aggravated arm.

Stretches and eccentric contractions similar to what is shown here: stretches and contractions except I didn't do the lifting part, just slowly lowering. Three sets of ten of each, usually morning and evening, a day or two on, a day off. Especially did them the days I climbed.

I bought one of these: armaid It wasn't as obviously helpful as the stretching and eccentric contractions but probably did help some especially when I first started using it.

Compression sleeve: sleeve was helpful in minimizing further aggravation during any strenuous exercise involving my arm.


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By Bill Czajkowski
From Albuquerque, NM
Jun 11, 2013
Triple Jeopardy starting from 1/3 of the way up.  No good pro except at this stance and after the upcoming slab.

kennoyce wrote:
Tendonitis isn't golfers elbow, it's tennis elbow. Golfers elbow is Tendonosis and as has been mentioned, reverse wrist curls are the cure. I've never had tendonitis, so I can't comment there.


Golfer's elbow and tennis elbow refer to, respectively, the inner and outer parts of the elbow joing. golfer's elbow tennis elbow

They're basically the same kind of injury, just different locations.


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By Bill Shubert
Jun 12, 2013
Me on Kamakaze 5.10a (Ozone)

Charles Vernon wrote:
Bill Shubert, I am confused, you say you had this for three years and never stopped climbing, but your profile says you started climbing in 2012.

I started bouldering in fall 2011. Started climbing in January 2012. My tendonitis came from weightlifting, I got it in late 2010, started going to a physical therapist (which is when it started getting better) about when I started bouldering. So maybe 2 years of tendonitis, not 3, sure, and I have been climbing/bouldering for just under 2 years of that.

I guess people on this site are sticklers for accuracy.


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By Ryan Williams
Administrator
From London (sort of)
Jun 12, 2013
El Chorro

Jeff G. wrote:
Golfers Elbow is medically known as Medial Epicondylitis and involves the wrist and finger flexor muscles and pronator teres. Tennis Elbow is Lateral Epicondylitis and involves the wrist and finger extensors and brachioradialis. Both can be inflammatory = Tendonitis Or they can be non-inflammatory and in the chronic stage = Tendonosis


Correct.

FYI, you can climb through these injuries, and it is almost always possible to eliminate the stmptoms with proper excercise. Ponation and supination excercise and wrist curla work wonders.


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By Jake Jones
From Richmond, VA
Jun 12, 2013
Me and the offspring walking back to the car after a day of cragging.

kennoyce wrote:
Tendonitis isn't golfers elbow, it's tennis elbow. Golfers elbow is Tendonosis and as has been mentioned, reverse wrist curls are the cure. I've never had tendonitis, so I can't comment there.


This is incorrect based on what therapists and doctors have told me. Tendonitis is the initial inflamation or tissue damage to a tendon. There is almost always inflammation, but not always tissue damage in the form of a tear or rupture of the tendon. It can occur anywhere. Medially or laterally in the elbow, the shoulder, the knee, virtually anywhere that there is a joint.

Tendinosis is a recurring degenerative condition where the tendon heals, or partially heals from damage (tear or rupture) that occurred, but repaired tissue scarred and hardened, making the tendon "tighter" which lessens range of motion, which usually causes more tearing and damage either at the same site as the previous damage, or a new site.

This is why true recovery times and rehabilitation methods are so much more involved for tendinosis vs. tendonitis- because it takes a lot of time in efforts to increase blood flow to the affected area, ensure that it has truly healed 100% all while trying to maintain or regain flexibility and range of motion so that that the injury doesn't recur and worsen.


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By kennoyce
From Layton, UT
Jun 12, 2013
Climbing at the Gallery in Red Rocks

Jake Jones wrote:
This is incorrect based on what therapists and doctors have told me. Tendonitis is the initial inflamation or tissue damage to a tendon. There is almost always inflammation, but not always tissue damage in the form of a tear or rupture of the tendon. It can occur anywhere. Medially or laterally in the elbow, the shoulder, the knee, virtually anywhere that there is a joint. Tendinosis is a recurring degenerative condition where the tendon heals, or partially heals from damage (tear or rupture) that occurred, but repaired tissue scarred and hardened, making the tendon "tighter" which lessens range of motion, which usually causes more tearing and damage either at the same site as the previous damage, or a new site. This is why true recovery times and rehabilitation methods are so much more involved for tendinosis vs. tendonitis- because it takes a lot of time in efforts to increase blood flow to the affected area, ensure that it has truly healed 100% all while trying to maintain or regain flexibility and range of motion so that that the injury doesn't recur and worsen.


Interesting, I thought I had read somewhere (a R&I article possibly?) that climbers generally get tendonitis in the outside of the elbow (tennis elbow), and tendonosis in the inside of the elbow (golfers elbow). I know that at least personally, I get tendonosis on the inside of the elbow if I don't do reverse wrist curls.


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By Jake Jones
From Richmond, VA
Jun 12, 2013
Me and the offspring walking back to the car after a day of cragging.

Yeah, I thought that too until I had it so bad I had to seek a doctor's help and she schooled me on the difference between the two. I think my misuse of the term was bugging her. It's kind of anal of her considering I have zero background in the medical profession but I didn't mind because she had a sweet rack.

Here's a decent article in pretty much layman's terms that explains it better than I could hope to if you're interested.

tendonitis vs. tendinosis


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By Aerili
From Salt Lake City, UT
Jun 12, 2013
Get down from there! <br /> <br />May 2013 <br />Photo by Duc

As far as I know, the terms tendonitis and tendonosis are not black and white and universally accepted in their medical definitions. I believe some professionals have advocated the two usages to indicate different presenting stages of a chronic injury but I am not sure there are literal insurance coding differences or if it influences a doc's treatment...because treatment isn't based on semantics per se.

Whatever Jake said...I really believe is not completely accurate. My god, you could ask 5 doctors or therapists about this and get 5 variable answers. So whatever.


Bill Shubert wrote:
I guess people on this site are sticklers for accuracy.

Forevar and evar! We accept nothing but the utmost in omnipotent perfection on this piece of gold!!!!!


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By Charles Vernon
From Tucson, AZ
Jun 12, 2013

Bill Shubert wrote:
I started bouldering in fall 2011. Started climbing in January 2012. My tendonitis came from weightlifting, I got it in late 2010, started going to a physical therapist (which is when it started getting better) about when I started bouldering. So maybe 2 years of tendonitis, not 3, sure, and I have been climbing/bouldering for just under 2 years of that. I guess people on this site are sticklers for accuracy.


Hope I didn't come across as a dick. I have had a nagging case of tendinosis for over a year and a half, so I read everything I can about the condition and particularly find it interesting when people have had successful experiences climbing through it. It's helpful for me to know that (1) you basically just started climbing; (2) climbing isn't what caused the injury and (3) you climb moderate routes. NO OFFENSE!

There are so many variations to this condition, and so many theories about how to treat it, that hearing about someone's experiences has become pretty meaningless for me without a lot of context.


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By Tyler W
From Utah
Jun 12, 2013
Scooby Snacks

Warm-up a lot, slowly.
Take fishoil a couple times a day.
Do opposition exercises like curls, pushups, dips, etc.


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By Jake Jones
From Richmond, VA
Jun 12, 2013
Me and the offspring walking back to the car after a day of cragging.

I agree Aerelli. As I said, I'm not a medical professional, but merely regurgitating what I was told by those that are. I have found that personally the quasi-accepted or unaccepted definitions have held true for me, and so correlatively have the treatments and rehabilitation for each. I'm not quite ready to run out and tell the doctor that helped fix me that she is a quack using terms that aren't universally accepted.


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By Bill Shubert
Jun 13, 2013
Me on Kamakaze 5.10a (Ozone)

Charles Vernon wrote:
Hope I didn't come across as a dick. I have had a nagging case of tendinosis for over a year and a half, so I read everything I can about the condition and particularly find it interesting when people have had successful experiences climbing through it. It's helpful for me to know that (1) you basically just started climbing; (2) climbing isn't what caused the injury and (3) you climb moderate routes. NO OFFENSE! There are so many variations to this condition, and so many theories about how to treat it, that hearing about someone's experiences has become pretty meaningless for me without a lot of context.

It's OK. I was mostly puzzled by why you even cared enough to compare my post with my profile.

And you're right, I was a new climber, doing moderate climbs. And as I said, I had to stop bouldering; the months I bouldered, my tendonitis got progressively worse, but once I switched to moderate top roping, it could heal. At this point I'm able to boulder again, and it doesn't seem to bother my tendons, but I never boulder more than once a week just to be safe.

I still do think that I serve as an example that at least in some cases, you can continue climbing with tendon issues. But you may need to stick with less strenuous climbing, and you definitely should have a good physical therapist.


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By Greg Kimble
From Colorado
Jun 13, 2013

I hope David Hodges is getting good info here.

Tendonitis and tendinosis are different and should be diagnosed and treated differently. They are highly misdiagnosed. Mr. Jones and Jeff G. are on the right track as far as what the literature says but whether practitioners properly diagnose and treat the issue correctly is another story all together. There are a lot of stupid PT's and Docs.

Many treatment plans for tendon issues center on controlling inflammation. The problem is there is no inflammation in -inosis. Realistically, there are only a few differences in treatment. Expect a longer healing time with tendinosis (months compared to weeks), skip NSAIDS (you'd be better off taking Vit C and E. Some in NSAIDs have been shown to impair tendon repair and there is no inflammation to control), you should be doing some sort of strengthening exercises instead of a solid 6 months of rest, and you should consider changing your habits when you get back into whatever caused the issue (warm-up routine,, # of days you climb, that sort of stuff.)


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By John Shippling
From morongo valley, ca
Jun 13, 2013

Hey I've been dealing with the same thing, and have found trigger point massage with the armaid device. I think of all the things I've tried this is giving me the most benefit. All this stretching, exercise, NSAID is basically bunk. Do some research and try it


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By Jake Jones
From Richmond, VA
Jun 13, 2013
Me and the offspring walking back to the car after a day of cragging.

John Shippling wrote:
Hey I've been dealing with the same thing, and have found trigger point massage


Deep tissue massage also worked wonders for me. Also, to the OP, FWIW, the most well-rounded and most effective treatment I have found is Julian Saunders's "Dodgy Elbows" program.

I really believe the keys for me were increasing weight and difficulty in the rehab exercises very gradually and incrementally, adjusting the angle of your arm during the exercises to agitate the affected area of the arm the most, and deep tissue massage, again aiming for agitation of the affected area.

Be extremely careful though and don't go overboard (should you choose to implement this program). Your best bet though, is to seek a qualified doctor that deals with climbing related injuries frequently- if that's possible. There is a very fine line between agitation pain and pain caused from overdoing it and worsening the injury. I think a good rule of thumb is to keep the "agitation" pain around a 5 on the 10 scale. Bad enough to make you wince and clench your teeth a little, but not bad enough to make your instinct want to kick in and stop what is causing the pain. Best of luck to you.


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By James Arnold
From Chattanooga
Jun 13, 2013
Chew toyed

I'm in my mid-40s and go through bouts fairly regularly, for me ASTYM is fantastic. follow the usual protocols (see above). Also, I have had some success in using the Theraband Flex-bar.

One other key, try to sleep with your arms "straighter"...sounds weird and perhaps apocryphal, but works for me....


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By MJMobes
From The land of steady habits
Jun 13, 2013
modern man

James Arnold wrote:
I'm in my mid-40s and go through bouts fairly regularly, for me ASTYM is fantastic. follow the usual protocols (see above). Also, I have had some success in using the Theraband Flex-bar. One other key, try to sleep with your arms "straighter"...sounds weird and perhaps apocryphal, but works for me....


I'm a firm believer in the arms strait thing, I wish I could do it!


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By Erik Pohlman
From Westminster, CO
Jun 13, 2013
Erik on Demise of Mr. Riffraff, near the top.  Photo by Jer Collins.

Good point Greg Kimble about the difference between tendonitis and tendonosis. We are actually finding more and more of these things we used to call -itises actually have no inflammatory component at all, which really affects the way we treat them (or at least it should, if you go to a practitioner who keeps up on the current evidence). Regarding the elbow, some, including myself, have even progressed to using the term epicondylalgia, which simply means 'pain near the epicondyle'.

The real problem is that this fairly common occurrence often really comes from something other than the tendons surrounding the epicondyle, or at least has other component to it. This could include things like nerve root compression, peripheral nerve irritation/tunnel syndromes/impaired neuurodynamics, referral pain from other joints or muscles, or even ligament sprains. It is fairly common for me to manipulate a patient's spine, for example, and get significant (sometimes complete) relief of elbow pain. The fact is, if you really care about getting down to the true cause of your elbow pain (or any pain) quickly, your best bet is to see a good physical therapist who will perform an in depth examination. I know some great clinics all along the Front Range (no, not just the ones associated with my own practice) so PM me if you want some more info.

Erik Pohlman, PT, DPT
Fit Physical Therapy, LLC


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By Aerili
From Salt Lake City, UT
Jun 13, 2013
Get down from there! <br /> <br />May 2013 <br />Photo by Duc

Yes, one refers to an inflammatory stage and one does not, generally speaking. And some medical professionals and some literature refer to these conditions as such. But there is still no universal agreement or exact diagnostic conditions for when to say one or the other. Biochemistry rarely works like "well, it's only/always this or it's that". To make things more confusing, the term tendinopathy is often used in place of either or both.

Docs and therapists are not necessarily "stupid" when both diagnosis and treatment aren't clear cut. Tendons and their pathologies are poorly understood (except by the mountainproject community, apparently).

Also, just because someone calls it "tendonitis" doesn't mean they won't treat it appropriately, even if no inflammation is present.

Good luck with your rehab.


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