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

2000).
    Following is a closer look at the two most common elbow injuries and their treatments.
MEDIAL TENDINOSIS AND TENDINITIS
     
    Pain near the medial epicondyle is commonly called golfer’s elbow or climber’s elbow. Pain develops in the tendons connecting the pronator teres muscle and/or the many forearm flexor muscles (responsible for finger flexion) to the knobby, medial epicondyle of the inside elbow.
    In many cases medial tendinosis is caused by muscular imbalances of the forearm and an accumulation of microtraumas to the tendons that result from climbing too often, too hard, and, most important, with too little rest. Consider that all the muscles that produce finger flexion are anchored to the medial epicondyle. Furthermore, the muscles that produce hand pronation (that turn the palm outward to face the rock) originate from the medial epicondyle. This subtle fact plays a key role in causing this injury: Biceps contraction produces supination (turning of the palm upward), but in gripping the rock you generally need to maintain a pronated, palms-out position. This battle, between the supinating action of the biceps pulling and the necessity to maintain a pronated hand position (to maintain grip with the rock), strains the typically undertrained teres pronator muscle and its attachment at the medial epicondyle.
    Given the above factors, it’s easy to see why the tendons attaching to the medial epicondyle are subjected to sustained stress and, inevitably, develop microtraumas. Just as muscular microtraumas are repaired to new level of capability, the tendons increase in strength and can withstand higher stress loads given adequate rest. Unfortunately, the repair and strengthening process occurs more slowly in tendons than in muscles. Eventually the muscles are able to create more force than the tendons can adapt to—the result is injury.
    Tendinosis will reveal itself gradually through increasing incidence of painful twinges or soreness during or after climbing. Tendinitis, however, is evidenced by acute onset of pain in the midst of a single hard move, and is usually followed by inflammation and palpable swelling. Even in these cases cumulative microtrauma may be involved in making the tissue vulnerable to acute trauma.
    As in treating other injuries, you can more easily manage tendinopathy (any tendon injury) and speed your return to climbing by early recognition of the symptoms and proactive treatment. The mature and prudent approach of attending to the injury early on versus trying to “climbing through it” could mean the difference between six weeks and six months (or more) of climbing downtime.
    Treatment of tendinosis and tendinitis has two phases: Phase I involves steps to relieve pain and reduce of inflammation (in the case of tendinitis); Phase II is engaging in rehabilitative and stretching exercises to promote correct alignment of collagen tissue and prevent recurrence.
    Phase I demands withdrawal from climbing (and all sport-specific training) and commencement of pain-reducing and anti-inflammatory measures. Icing the elbow for twenty minutes, three to six times a day, and use of NSAIDs will help reduce inflammation and pain following injury; cease use within a few days to a week. A cortisone injection may be helpful in chronic or severe cases, though this practice is somewhat controversial among physicians and, in fact, may be detrimental to the healing process (Nirschl 1996). Depending on the severity of the injury, successful completion of Phase I could require anywhere from two weeks to two months.
    The goal of Phase II is to retrain and rehabilitate the injured tissues through use of mild stretching and strength-training exercises. Since forearm-muscle imbalance plays a primary role in many elbow injuries, it’s vital to perform exercises that strengthen the weaker aspects of the forearm—hand pronation for medial tendinosis and hand/wrist extension for lateral tendinosis (more on this in a bit).
    Always perform some general warm-up activity and consider warming the elbow directly with a heating pad before beginning the stretching and strengthening exercises. Stretch twice daily the forearm flexor, extensor, and pronator muscles as described in chapter 6. Once the stretching exercises have successfully restored normal range of motion with no pain, you can introduce strength training with the Forearm Pronator exercise shown on page 121. It’s important to progress slowly with training