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

exercises and to cut back at the first sign of pain. Begin with just a couple of pounds of resistance and gradually increase the weight over the course of a few weeks. Use the stretching exercises daily, but do the weight-training exercises only three days per week.
    After three to four weeks of pain-free training, begin a gradual return to climbing. Start with low-angle and easy vertical routes, and take a month or two to return to your original level of climbing. Continue with the stretching and strength-training exercises indefinitely—as long as you are a climber, you must engage in these preventive measures. Failed rehabilitation and relapse into chronic pain may eventually lead to a need for surgical intervention.
    Finally, let’s take a look at the use of counterforce bracing, or circumferential taping of the upper forearm, as a curative (or preventive) measure for elbow tendinosis. A counterforce brace designed specifically for elbow tendinosis can provide some comfort by dispersing forces away from the underlying tissues (Nirschl 1996). These braces are not a substitute for proper rehabilitation, however; they instead act only to help prevent recurrence after full rehabilitation. There is little evidence that supportive taping of the forearm provides the same benefit as use of a counterforce brace.
    Treating Elbow Tendinosis and Tendinitis
     
    1. Cease climbing and sport-specific training.
    2. Apply ice to the injured area and take NSAID medications only if the injury produces visible or palpable swelling (most elbow tendinopathy does not). Cease use of ice and NSAIDs as soon as swelling diminishes—further use will slow healing.
    3. Never use NSAIDs to mask pain in order to continue climbing while injured. Regular use of NSAIDS (and smoking) may actually weaken tendons!
    4. If no swelling is present, begin mild stretching, light massage, and use of a heating pad (ten to fifteen minutes) three times per day. Most important is twice-daily use of the forearm stretches shown in chapter 6.
    5. If no swelling is present and if pain is minor, engage in rehabilitative exercises on an every-other-day basis. Perform some warm-up activities such as arm circles, finger flexions, massage, or use of a heating pad. Use Reverse Wrist Curls for lateral tendinosis and Forearm Pronators for medial tendinosis.
    6. Cautiously return to climbing when your elbow is pain-free and no sooner then after two to four weeks of strength-training exercise. Begin with easy, foot-oriented climbing for the first few weeks and limit use of the crimp grip. Cease climbing if you experience pain while climbing and immediately return to step 2.
     
     
LATERAL TENDINOSIS
     
    Lateral tendinosis, commonly called tennis elbow or lateral epicondylitis, is an irritation of the tendons that attach the forearm extensor muscles to the lateral epicondyle on the outside of the elbow. The forearm extensor muscles are antagonists to the forearm flexor muscles used so prominently in gripping the rock and, therefore, the extensors are often disproportionately weak compared with the flexors. Furthermore, grip strength is greatest when your hand is in the extended position—this explains why your arm “chicken wings” out from the rock when you struggle to grip small crimp holds. It’s the extensor muscles that facilitate this chicken wing position and, thus, constant straining to stick crimp holds can lead to tendon injury where the extensor muscles attach to the lateral epicondyle. (Note reducing your use of the crimp grip will lower your risk of tendinosis.)
    Onset of pain is typically gradual, and will first appear after a hard day of climbing. Without rest and treatment, the condition will progressively worsen to the point that climbing becomes prohibitively painful and even everyday tasks are hampered. Since such a severe case often requires a six-month (or longer) rehabilitation period away from climbing, it’s paramount that you take the necessary steps to mitigate this injury early on.
    The treatment protocol for lateral tendinosis is similar to that described above for medial tendinopathy. Time away from climbing is mandatory—very few people successfully climb through elbow tendinosis of either kind. Frequent icing and limited use of anti-inflammatory medication is helpful during the initial period of pain, but these treatments should never be used to allow continuation of climbing. As pain and swelling subside, daily use of the stretching