Can I hear some Medial Epicondylitis success stories please?!

I've been struggling with this condition for almost a year now, and tried everything.  I bought Esther Smith's pdf, I've been to an array of docs, I even hired Julian Saunders (author of the "Dodgy Elbows Revisited" article in R&I) and talked to him over skype for advice.  I've been doing PT for 6 months now, and eased up on the climbing substantially.  But it's still getting worse.  

It used to be that it would hurt only after a session then be fine the next day.  Now it's hurting while I'm climbing, so I've backed off further.  It feels like this is never going to get better.  Can anyone share a success story as a way of cheering me (and others) up on this Christmas day?  I need it.

Elbow tendinitis is the worst. Based on my elbow tendinitis experience (on and off for 3 years before fully recovered), EXTENDED REST WILL NOT RESOLVE THE ISSUE. You need to actively work on on it. If the pain is very acute then yes rest for a couple of weeks. But then you will need to actively fix the issue. Everyone is different but I will detail the two things that resolved my ET.

I had ET BAD for 3 years. I was depressed and didn’t know how to resolve it, and this was because I didn't initially know what the root cause of my ET was. For me, it was severely underdeveloped triceps and forearm extensor muscles. This imbalance in my arm muscles caused elbow pain of varying intensity over the years. The imbalance is very easy for climbers to develop - climbing is so fun that you don't realize the workout you are giving your pulling muscles. And all you want to do is climb, but you are neglecting your push muscles.

1. I began devoting one day a week to pushing and triceps workouts. Slowly at first because it was a little painful, but at this point I didn’t give a shit because after 3 years I was willing to do anything. I still do this once a week where I lift push muscles (bench press, dumbbell press, pushups, triceps pull downs, etc) for about 1-2 hours. A couple sets of pushups a week did NOT cut it. I needed to absolutely BLAST my triceps the same way I was with my pulling muscles. Consider this fact - your triceps should be 2/3 of the mass of your upper arm!

2. Stretching my forearms. There are three forearm stretches I do every day. Flexors, extensors, and a rotational stretch.

After doing this for several weeks I noticed results and now climb pain free. Some things I noticed over the years that aggravated my ET the worst:
1. Hard gym crimping - especially clinging onto crimps for extended times
2. Refrigerator style moves
3. Dehydration
4. Lack of rest

Not everyone is the same. Not everyone recovers from ET the same. But people with ET all have one thing in common, rest does NOT resolve it. Hope all this helps. Feel free to PM.

It’s Not Your Elbows...check out this guy...https://www.youtube.com/watch?v=dbDNrAWFadw ...been super helpful for my elbows and his other vids on knee, wrist and shoulder pains

and read about this stuff https://store.draxe.com/collections/collagen/products/collagen-protein 

Check into nitro glycerin patches. I’ve dealt with this for years and have tried everything. They are realitivly obscure for tendinitis treatment. I spoke to a sports med doc at northwestern medicine in Chicago and they gave me a prescription for these patches. At first I was very skeptical but I can say unequivocally that this patch cured my severe bout of tendonitis that plagued my climbing for years three, after wearing the patch consistently for three months my pain was gone. It does take a while for the medication to work but if your dealing with severe symptoms, three months isnt really that long. The patch is for high blood pressure and draws blood to the area the patch is on. So tendons don’t heal quick because when your older they barely get any blood flow, the thought with the patch is it draws blood to the area which helps heal the tendon. It is an off label use for the medication, there was one study that my doc showed me on the patch that seemed promising. Definitely worth checking into if your tendinitis is severe. Here is a photo, I truly swear by this. You won’t find any info about it online. I’ve done exstensive research and only found a small blip on an ultra running blog. Also if you haven’t tried the stretch on Tom Randall’s blog for golfers elbow, give it a shot, definitely helped me a bunch. Good luck feel free to pm if you have any questions or want the link to the study the doc gave me.

grog m wrote: Elbow tendinitis is the worst. Based on my elbow tendinitis experience (on and off for 3 years before fully recovered), EXTENDED REST WILL NOT RESOLVE THE ISSUE. You need to actively work on on it. If the pain is very acute then yes rest for a couple of weeks. But then you will need to actively fix the issue. Everyone is different but I will detail the two things that resolved my ET.

I had ET BAD for 3 years. I was depressed and didn’t know how to resolve it, and this was because I didn't initially know what the root cause of my ET was. For me, it was severely underdeveloped triceps and forearm extensor muscles. This imbalance in my arm muscles caused elbow pain of varying intensity over the years. The imbalance is very easy for climbers to develop - climbing is so fun that you don't realize the workout you are giving your pulling muscles. And all you want to do is climb, but you are neglecting your push muscles.

1. I began devoting one day a week to pushing and triceps workouts. Slowly at first because it was a little painful, but at this point I didn’t give a shit because after 3 years I was willing to do anything. I still do this once a week where I lift push muscles (bench press, dumbbell press, pushups, triceps pull downs, etc) for about 1-2 hours. A couple sets of pushups a week did NOT cut it. I needed to absolutely BLAST my triceps the same way I was with my pulling muscles. Consider this fact - your triceps should be 2/3 of the mass of your upper arm!

2. Stretching my forearms. There are three forearm stretches I do every day. Flexors, extensors, and a rotational stretch.

After doing this for several weeks I noticed results and now climb pain free. Some things I noticed over the years that aggravated my ET the worst:
1. Hard gym crimping - especially clinging onto crimps for extended times
2. Refrigerator style moves
3. Dehydration
4. Lack of rest

Not everyone is the same. Not everyone recovers from ET the same. But people with ET all have one thing in common, rest does NOT resolve it. Hope all this helps. Feel free to PM.

Resting for months was the ONLY way I beat elbow tendinitis. That meant no pushups or presses, climbing or mountain biking. I had to brush my teeth with my other hand. I haven’t had any more problems for years, and I still climb a lot. I don’t climb as hard as I used to, which is partly due to other injuries. 

I had it for a few years-- what seemed to help the most was all of the antagonistic training exercises, as it is fundamentally an imbalance problem. Grogs suggestions are good. Ignore anyone who thinks that a nutritional supplement will help...

Seconding what Grog said - if anything, inactivity made it worse for me.  Pushups, stretching helped but couldn’t quite kick it.  Oddly enough, Ibuprofen did the trick for me - had to take it for a few days for an unrelated injury, and my ME ended up dissapearing.  My theory is that I must have been wrapped up in some sort of weird positive feedback where my muscle was spasming and the Ibuprofen relaxed it enough to heal, but hard to say.  It’s a weird condition.

Try the nitro patches.  Try incorporating pushups in your routine.  Try formal pt.  If you still have problems then come to me and we can try platelet rich plasma.   You can google my name and find my practice. None of these treatments are 100%.   ( including prp )
Tom Maino

I’ve had it numerous times, both medial and lateral. Never been sure why it kicks off but I know pull-ups and lockoffs are bad. Oddly, hand jams are almost therapeutic so I assume crimping aggravates it some. Lateral seems a little easier to treat but not exceedingly so. For me, not climbing only helps as long as I don’t climb. As soon as I go back to climbing it starts back up with no noticeable improvement.

Most effective for me has been eccentric training focused on the problem area. Cast iron frying pan (10”) is about the right weight but adjust so that it is stressful but you can do three sets of ten reps, count of ten for each lower. I try for every day but usually get about 5 days a week, particularly ill after climbing. It’s slow. About two months to get noticeable improvement, 4-6 months to recover completely. Put your forearm on a flat surface, elbow flex fairly straight (though over the weeks I adjust that to where it’s most painful/irritating). For medial start with the sore spot (inside of your elbow) facing up, wrist flexed so the pan is pointing toward the ceiling. Important to not wrap your thumb around the handle but keep on the same side as your fingers. Lower for the ten count (can’t overstress slow is good) to the maximum range of motion. Using your other hand, raise it back up and repeat. Never flex your affected forearm with the weight in your hand. The idea is that the effected muscle is being stretched under stress/weight.

As I said, it takes a while, but it works very depndably for me. Good luck whatever you choose!
I’ll note that I’ve seen no evidence of the imbalance theory and that I have had tendonitis while doing significant push training exercises including weight lifting and pushups. However, I doubt adding that, and stretching, will hurt, and the stretching in particular might help.

It took me two years to recover. put a tight band around it and stopped doing strenuous work with that arm (but still did sports or used it at work just in lower intensisty). still could climb or ride a bike but in lower grades. from other people who I talked to, it usually takes this amount of time to recover.

mpech wrote: I had it for a few years-- what seemed to help the most was all of the antagonistic training exercises, as it is fundamentally an imbalance problem. Grogs suggestions are good. Ignore anyone who thinks that a nutritional supplement will help...

Collagen /ˈkɒlədʒɪn/ is the main structural protein in the extracellular space in the various connective tissues in the body. As the main component of connective tissue, it is the most abundant protein in mammals,[1] making 25% to 35% of the whole-body protein content. Collagen consists of amino acids wound together to form triple-helices l of elongated fibrils.[2] It is, mostly, found in fibrous tissues such as tendons, ligaments, and skin.

Depending upon the degree of mineralization, collagen tissues may be rigid (bone), compliant (tendon), or have a gradient from rigid to compliant (cartilage). It is also abundant in corneas, blood vessels, the gut, intervertebral discs, and the dentin in teeth.[3] In muscle tissue, it serves as a major component of the endomysium. Collagen constitutes one to two percent of muscle tissue and accounts for 6% of the weight of strong, tendinous, muscles.[4] The fibroblast is the most common cell that creates collagen

As a supplement, when hydrolyzed, collagen is reduced to small peptides, which can be ingested in the form of dietary supplement or functional foods and beverages with the intent to aid joint and bone health and enhance skin health.[16][17][18][19][20][21][22] Hydrolyzed collagen has a much smaller molecular weight in comparison to native collagen or gelatin, study suggests that more than 90% of hydrolyzed collagen is digested and available as small peptides in the blood stream within one hour. From the blood, the peptides (containing hydroxyproline) are transported into the target tissues (e.g., skin, bones, and cartilage)[23][24][25], where the peptides act as building blocks for local cells and help boost the production of new collagen fibers. (Wikipedia = Collagen)

T G wrote: John, you say you've worked with doctors and have been doing PT, but it sounds like you're continuing to climb as if you didn't have your elbow issues. 

I've reduced the volume of climbing/training dramatically since the onset of my elbow problems.  I was climbing 4 days/week a year ago, and now it's 2 days/week with sessions being about half as long.  Perhaps this is still too much since I'm not making progress with the elbow.

I did try complete rest as well (2 months of zero climbing) but I didn't find any relief whatsoever doing that (which I've since learned is common).

 the advice given by Bill C. to do eccentric strengthening is good, and has been very reliable for me, too. But you also need to do more– and less. You need to be doing the PT work several times per day over the course of months, while also backing off quite a bit from the climbing. That doesn't mean you can't or shouldn't climb, but it sounds like you may be doing too much. Aggressive, somewhat uncomfortable massage directly on the affected tissue several times per day was also very effective for me– idea being to break up and stimulate the degenerative tissue (i.e. encourage blood flow) to encourage your body to recognize it as an injury and to "rearrange" the tissue and begin to heal properly.

I've been doing the eccentric exercises (2 sets in the morn, 2 in the evening, every other day).  It's hard for me to keep doing this exercises sometimes because they GREATLY exacerbate my symptoms.  Everyone says to find the angle for the elbow that really stresses the medial epicondyle, so I do that (it's around 90 degrees for me), but it makes my elbow really sore the next day.  To me that seems counterproductive, but I keep doing it anyway.  For 4 months now.

My elbow pain will completely go away for 1-2 days sometimes.  But it always comes back, and lately worse than ever.  It's probably degenerative at this point.  Deeply frustrating!

Lisa Erickson successfully treated my medial epicondylitis back in 2016 and it has not returned. She is located in Boulder

I struggled with it for about three years and tried all sorts of different things-PT, Dodgy Elbows, months of rest. None of that worked. Like you, I was worried that it was degenerative and not likely to ever go away. What worked in the end was simply climbing consistently (2x week), but climbing at a far, far lower grade than I usually climb. I would go to the gym and do a bunch of routes in the 5.6 to 5.8, maybe 5.9 max range and after months of that, slowly built up to harder grades. It was boring but it worked; my tendinosis hasn't returned in four years and I've been able to climb as hard if not harder than I ever have. 

I had this condition also, these things work like a charm...

https://www.theraband.com/theraband-flexbar-resistance-bar.html

This is what I've tried so far:

• Complete rest (didn't help)
• Cutting back on climbing volume
• Reverse wrist curls
• Antag work (benchpress, tricep work, dips)
• Theraband Flexbar
• Wave Tool (massage)
• Armaid (massage)
• Dodgy Elbows Revisited (eccentrics)
• Tom Randall stretch (also mentioned in Make or Break, along with some other things)
• Ice, heat, and massage therapy
• Acupuncture
• Two local PTs, saw Lisa Ericsson back in August, Julian Saunders in September

What I haven't done: MRI, PRP, cortisone, surgery.  (I'm unlikely to do any of those.)

---------------

In a lot of cases above, I'm wondering if the thing that finally cured your elbow was actually the thing that worked, or if it just resolved on its own, coincident with the last thing you tried?!  Hard to know I guess.

For me the nitro glycerin patch cured my golfers elbow three months of wearing it consistently and the pain was gone and stayed away, I’m six months out since being pain free and climbing harder than ever.I was in a similar boat to you where I tried everything and I mean everything. Everything on your list, plus more ( the collagen supplement being pushed as well, ultrasound therapy, prp everything) I saw climbing doctor Lisa Erickson  and nothing worked. This patch isn’t some gimmick I’m trying to push. I truly believe these patches could be revolutionary when treating tendonopothy. It is at least worth bringing up to a doctor and getting their input. 

Jack Sparrow wrote: For me the nitro glycerin patch cured my golfers elbow three months of wearing it consistently and the pain was gone and stayed away, I’m six months out since being pain free and climbing harder than ever.I was in a similar boat to you where I tried everything and I mean everything. Everything on your list, plus more ( the collagen supplement being pushed as well, ultrasound therapy, prp everything) I saw climbing doctor Lisa Erickson  and nothing worked. This patch isn’t some gimmick I’m trying to push. I truly believe these patches could be revolutionary when treating tendonopothy. It is at least worth bringing up to a doctor and getting their input. 

I may try it, but the only study I could find for Nitro on elbows was Bukhari and Murrell, which showed no difference from placebo at 5 years out.

https://www.ncbi.nlm.nih.gov/pubmed/22244067

For sure that makes sense, I’m less than a year out from my use so who knows where I’ll be in five. I can say that I’ve been climbing the past six months and feel great. Definitely beats a cortisone injection which will have you feeling like a rockstar for a few weeks then crash and burn. 

John RB wrote: This is what I've tried so far:...
In a lot of cases above, I'm wondering if the thing that finally cured your elbow was actually the thing that worked, or if it just resolved on its own, coincident with the last thing you tried?!  Hard to know I guess.

Bingo. There's a lot of cognitive science I could cite (happy to give anyone who's writing their PhD dissertation a Zotero dump, or you could just attend a meeting of the Society for Medical Decision Making) but John RB has nailed the bottom line. Most of the "cures" people share, and genuinely believe in, are what are known as "cognitive illusions," the equivalent of the optical illusions that make two lines look different lengths when  they're the same, etc. The reality is that only two things have halfway reasonable (steroid etc. injection advocates: those are at best only 1/4 reasonable, and only short-term) evidence (as in controlled studies) for effectiveness: activity modification and eccentric strengthening. Everything else is tincture of time as the actual active ingredient, attributed to whatever you desperately tried last.

Cut way down on the intensity. If you think you have, you're probably half right. (90% of sports medicine is sports psychology, getting driven athletes to actually cut back to what their connective tissues will withstand and start to heal - far harder than the actual medicine part). Do the eccentric exercises. Be patient.

Yeah, right, and I'm throwing stones from within my glass house here too, as I keep bouldering while doing my eccentric strengthening for my right flexor digitorum tendinosis. But that's the human condition, eh? Climb on. (Circumspectly.)

Confession: I am pretty good about backing off when things hurt a lot.  My weakness is that as soon as I feel healthy again (ie, zero pain), I go absolutely bonkers and climb like it's 1999.