Climber's Elbow Hopelessness

Dealing with my 2nd bout of climber's elbow. The pain is intense. I'd love to hear some healing success stories to lift me up. I know the exercises... but how long does it take?  Thanks.

Check out Dr. Tyler Nelson and Dave Macleod (mostly Tyler Nelson). It can heal a lot faster if you actively work on it and load your body in the right way instead of just resting and really low intensity stuff. 

I'll just tell you what I learned through experience after having the first case in 1970. Doing pull-ups to very tight high positions and similar climbing moves can make one susceptible to the condition. I stopped climbing for a long time, then gradually got back into the activity, and even today at 84, still end a session at the fitness center or playground by straightening each arm vertically with my hand on a flat surface at right angles to the arm, gently leaning on the arm and stretching slightly toward the fingertips. It's worked for me since 1971. 

But I'm sure there are modern procedures much more effective.  It's very frustrating. Bachar had problems with it and tried a number of approaches.

I had a bad bout of climbers elbow. I did rehab religiously every day for probably a month until the pain went away completely and then continued probably 4 months after to make sure it was healed. I do more antagonist training now. And now warm up *a lot* before starting climbing. It hasn’t come back in any real way.

theclimbingdoctor.com/ this was my main resource for exercises  

See a physical therapist. Climbers elbow took me out for 7 months. Doing therapy exercises a few days a week manages it

Are you bouldering on slopey/compression style stuff often? I got the elbow bad when I was bouldering 4 times a week on mostly slopers. A couple weeks off and route climbing made it a lot better

The flex bar drills for "tennis elbow" has gotten mine pretty close to fixed. Everyday drills indefinitely, only feeling the benefits after about 2-3 weeks.

My first bout of climber's elbow, about 10 years ago, I tried everything...all the exercises, all the work, all the therapy, and, of course, just not climbing.  Nothing worked.  Then...I started picking up and holding my young daughter with my other arm...pain went away in about 2 weeks!

My second bout of climber's elbow took place over the last two years.  Again, I tried everything.  From aggressive therapy to taking time off, a phone consult and tailored sessions with that elbow guy who often writes for Climbing, that stretch proposed/invented by one of the Wide Boyz Brits...nothing worked.  Then...I stopped using my NordicTrak ski erg.  I bought this device after a knee injury skiing.  For two years of rehabbing by knee, the standing, upright, vertical ski erg was my daily or every-other-day cardio.  Apaprently, it was also the stress that was wrecking my elbow.  I stopped with the ski erg...elbow pain subsided dramatically in about two weeks, and although it still twinges now and again, it's basically not a problem. 

The lesson--try everything--including looking to your daily life for stressors and triggers.  

Also, don't completely stop exercising.  That was always the worst for me.  Do push ups, pull ups, hangs, wrist curls, wrist extensions, finger exercises, and so on...just don't do them to full extension of flexion...move them through a small middle range of motion.  You still get a training benefit, but it's not as stressful on your joints.  

One last thing I was considering...do you usually sleep on one side, the side with the elbow injury, with that arm bent under your head?  Perhaps you are compressing tissue and restricting blood flow at night?

Good luck--there is life after climber's elbow!!!

I also dealt with it for about a year - and still feel it just a little bit. I learned that it's important to self-regulate - if something isn't working after 3-4 weeks of trying it, switch it up. Different elbows respond to different loading: some will benefit from light weight, high reps and some from the inverse. Try different exercises, see a PT, mix in massage and scraping. Best of luck!

The key is a combination of doing antagonist muscle exercises, (push ups or other tricep/chest exercises, reverse wrist curls) and doing down climbing or other stretching under load such as pull up or bicep curl negatives.  Resting appropriately also helps but it does not help to stop altogether for long periods because you become weaker and the problem gets worse. 

I started getting bicep tendinitis from weighted pull ups recently so I took off a month of climbing but I still remained active by swimming and doing light workouts with push ups and tricep exercises.  It is gone for now and I can resume upping the weight on the pull ups again. 

Big Red wrote:

I also dealt with it for about a year - and still feel it just a little bit. I learned that it's important to self-regulate - if something isn't working after 3-4 weeks of trying it, switch it up. Different elbows respond to different loading: some will benefit from light weight, high reps and some from the inverse. Try different exercises, see a PT, mix in massage and scraping. Best of luck!

While self-regulation is important, I would hesitate to abort a rehab plan simply bc it isn’t “working” after 3-4 weeks.

For example, my one and two-arm isometrics protocol for golfers elbow spanned several months.  I didn’t start seeing real benefits until way past 3 weeks.  Now, 1.5 years later, I’m fully rid of medial epicondylitis that I thought would never leave.

Andrew Denmark wrote:

While self-regulation is important, I would hesitate to abort a rehab plan simply bc it isn’t “working” after 3-4 weeks.

For example, my one and two-arm isometrics protocol for golfers elbow spanned several months.  I didn’t start seeing real benefits until way past 3 weeks.  Now, 1.5 years later, I’m fully rid of medial epicondylitis that I thought would never leave.

You're absolutely right - my 3-4 weeks was under the guidance of a PT so YMMV. That being said, one of the biggest frustrations I had was picking a protocol (without a PT) and not seeing any change after months.

I've had success with this protocol

https://vimeo.com/110276040

I had it for 1.5 yrs in my right elbow, then after that in my left.

I tried EVERYYYTHING, including doctors, every stretch and PT method, etc.  

My theory: it eventually goes away and when it does, people ascribe the solution to whatever the last thing they were trying when it finally resolved.

Things I'm pretty sure DO NOT work:

• Complete rest
• More of whatever caused it

Climbing 5.7 slab all day multi-pitch is often helpful.  It's low loads, high volume, your heart is pumping new blood, etc.  And it keeps you "fed" for climbing enough to keep you off the steep stuff.

Dodgy Elbows (revisited) was a game changer for me: http://drjuliansaunders.com/ask-dr-j-issue-223-dodgy-elbows-revisited/

A few addendums:

1. Dave MacLeod mentions in one of his videos that it's worthwhile to tolerate some level of pain, because a) if you don't stress the tissue, it doesn't get stronger, and b) the tissue which is causing pain isn't the only tissue involved in the movement that's causing pain--if you stop the movement, you're allowing all the healthy tissues involved in the movement to get weaker. The wisdom of this latter point has become more clear to me in the past year, when after a labral tear, I stopped doing pull-ups and Pendlay rows, and resuming those exercises resulted in a recurrence of my previously-fixed elbow issues, and a lower back injury, respectively. Thankfully both these injuries were minor (fixed in under a month of corrective exercise). Maybe the level of pain from pull-ups or climbing is too great, but if you can find a weights that are reasonable for, say, lat pull-downs and Pendlay rows, these can both help correct the issue and prevent healthy tissue unrelated tot the issue from deteriorating.
2. It's worth looking at other aspects of your training. Every acute injury I've ever had occurred during a significant sleep deficit. Minor overuse issues seem to correlate strongly with eating grains (I love granola, but whenever I eat a lot of it, I start getting elbow and knee pain). I'm significantly over my ideal weight right now, which has been putting extra stress on my body during training and climbing, so I've had to be very cautious about adding weight to my bodyweight exercises as I get my weight down to where I want it again. As Dave MacLeod says, everything you do is training for something, so look holistically at your lifestyle and see if there's anything else that might be contributing to your injury.
3. The evidence for omega-3s roles in joint health seems fairly strong to me. Eric Hörst is pretty psyched on a combination of vitamin C and hydrolized collagen protein--he's a biased source because he sells it, and it's not clear from the evidence I've seen whether vitamin C alone or collagen protein alone would be equally effective, or whether other proteins (such as whey) would also be equally effective--but if you have the money to burn it doesn't seem to hurt. There seems to be weak evidence around vitamin D, magnesium, and zinc (separately) all individually helping with joint pain--and again these are generally pretty good for you so even if they don't actually help there's no harm in taking them.

I have a mild case of that in my left arm due to working overhead for an intense week or so. I also have tendinitis in my left foot ball. For both I'm applying  ice packs four times a day and getting on an ibuprofen schedule of 8 200 mg per day. Going to do this for four weeks and see how it goes.

Tim Stich wrote:

I have a mild case of that in my left arm due to working overhead for an intense week or so. I also have tendinitis in my left foot ball. For both I'm applying  ice packs four times a day and getting on an ibuprofen schedule of 8 200 mg per day. Going to do this for four weeks and see how it goes.

I've zero info on the foot injury, but with regards to the elbow, the paper I linked claims that ice and ibuprofen are ineffective, as tendinosis is not inflammatory:

"The almost religious adherence to using ice for the management of an acute injury has largely been debunked. Although great for pain management, ice does not alter healing rates, or even reliably affect inflammation. Heat, on the other hand, enhances blood flow. A hot pack for 15 minutes a day will speed healing and make you feel warm and fuzzy."

And also (about Ibuprofen and other NSAIDs):

"Tendinosis is not inflammatory. While ibuprofen does wonders for deadening the pain, it only masks the problem and can cause severe internal bleeding due to stomach ulceration. NSAIDs kill more people each year than car crashes."

What you're doing is just a pain management strategy. What you're likely to experience here is that your plan fixes the pain enough that you can resume activity and exacerbate the underlying issue, which will either get worse to the point that the pain management strategy doesn't work, or return worse than before once you stop the pain management strategy. Having experienced this myself, I wouldn't recommend it.

Yeah, I got talked into icing it and I was aware that it has mostly been debunked now. So what is effective for tendinosis? I'm out the door so I can't read your entire link right now.

I had really bad climber's elbow for a long time. I know this isn't what you want to hear, but I tried a lot of things and the only thing that worked was taking a few months off. I have not had problems since. I am a lot more careful with it now though and do preventative exercises (pushups, pronators, etc.) and stop if it feels even a little tingly. 

Daily flex bar exercises for a month or two fixed mine. Climbing Doctor link.

Tim Stich wrote:

Yeah, I got talked into icing it and I was aware that it has mostly been debunked now. So what is effective for tendinosis? I'm out the door so I can't read your entire link right now.

It basically boils down to these three exercises:

Note that you're not using the muscle to return the load to the starting position, you're using the other hand. This is important because you want to lengthen the muscle under load, not contract it under load.