Training for Climbing, 2nd: The Definitive Guide to Improving Your Performance (How To Climb Series)

anti-inflammatory effects that would benefit climbers.
    In conclusion, you should just say no to regular use of vitamin I and all other NSAIDs, since in most cases it will do you more harm than good. Limit use of NSAIDs and the RICE method to the few days following a painful and swollen acute injury. When inflammation and pain subside, begin use of massage and a heating pad for ten to twenty minutes, three times a day, to enhance rate of healing. Finally, consider daily, year-round supplementation with omega-3 EFAs for their natural anti-inflammatory and heart-healthy effects—at less than fifty cents per day, it’s a wise investment and a prudent adjunct to NSAID use.
     
    A recent German study (Hochholzer 2005) evaluated twenty-four junior climbers with nontraumatic epiphyseal fractures. Interestingly, only one of the injured climbers was a girl—so boys seem to be at greater risk—and all were between the ages of thirteen and sixteen. Injury to growth plates can cause permanent damage, so a temporary withdrawal from climbing is essential for adolescents experiencing finger joint pain. Parents and coaches must enforce a rest period of at least a few months or more away from climbing until the youth climber is asymptomatic. In terms of prevention, parents and coaches should limit climbing activity to three days per week during the adolescent growth spurt, and disallow use of advanced training exercises such as campus training, hypergravity training, and intensive fingerboard training until at least age sixteen or the end of puberty (achievement of maximum adult height).

Elbow Tendinopathy
     
    Pain near the bony medial (inside) or lateral (outside) epicondyles of the elbow is an exceedingly common ailment among serious climbers. In most cases the onset of pain is very gradual: A schedule of frequent climbing produces microscopic injury that fails to repair before the tendon is subjected to additional strain. A tendinosis cycle develops and amplifies as breakdown exceeds repair and the microtraumas accumulate over many weeks and months. In the early stage of tendinosis, pain is dull and may be felt only after a day of climbing; however, pain experienced in the course of everyday activities such as opening a door or washing your hair is a sign of advanced tendinosis. The hallmark of tendinosis is its gradual onset and lack of inflammation and visible swelling.
    A similar yet less common and often misdiagnosed injury is tendinitis. The suffix itis means “inflammation,” and the term tendinitis should be reserved for acute tendon injury accompanied by inflammation and palpable swelling. In climbing, tendinitis occurs most often near the medial epicondyle as the tendon is injured during a maximal one-arm pull on a small hold or in performing advance training exercises without adequate warm-up or training experience.
    A third, more subtle class of tendon injury is paratenonitis (formerly termed tenosynovitis and tenovaginitis), an inflammation and degeneration of the outer layers of the tendon and the synovia-lined tendon sheath. Paratenonitis can develop in the tendons of the arms and fingers and in concert with either tendinosis or tendinitis.
    Regardless of which tendon ailment you possess, the one commonality is the extremely slow rate of healing. While muscles possess abundant blood flow and a relatively rapid rate of healing, blood flow to the ropelike collagenous tendons is poor, and laying down new collagen make take a hundred days or more (Khan 1999). Exacerbating these slow-healing injuries is the tendency of enthusiastic climbers to rush back into training and climbing prematurely. Worse yet, researchers have discovered that an enduring tendinosis cycle often leads to collagen repair with an abnormal structure and composition, thus making the repaired tendon less able to withstand tensile stress and more vulnerable to further injury. Following acute injury, the strength of a repaired tendon can remain as much as 30 percent lower than normal for months or even years (Leadbetter 1992; Liu 1995).
    In severe, chronic cases of elbow tendinitis or tendinosis, surgery may offer the only lasting remedy. The most popular procedure is to simply excise the diseased tissue from the tendon, then reattach healthy tendon to the bone. Eighty-five to 90 percent of patients recuperate in three months, 10 to 12 percent have improvement but some pain during exercise, and only 2 to 3 percent have no improvement (Auerback