29 December 2009

Rehab for Golfers elbow for climbers

Loads of you have been asking for more info on the rehab work I’ve been doing on my elbows of late. I’ve been really impressed and heartened by how effective it’s been. The first thing to say is that rehab only works inside the bigger picture of treating an injury, i.e. correcting the cause and taking other steps to lower the overall stress on the affected area. The other steps are changing many different things in your lifestyle and routine outside of the climbing, but also some of the tactics within the sport routine.

To handle all of this is much more than a blogpost obviously. Hence I’m back to working on what was meant to be my first book - about the whole picture of preventing and treating climbing injuries. In this post I’m sticking to just the headlines of the rehab work:

First off I’ve been doing hot/cold water immersion to increase blood flow. In the past I’ve used just cold on my hands which seem to handle this better and evoke the Lewis reaction faster. The elbows seem to respond slightly better to hot and cold alternately. I’m presuming for now this is because they are not body extremities by comparison and not geared up for profound and rapid vasodilation but have yet to investigate this. This is just my experience though, I’ve not yet trawled through more sources of evidence, and there seem to be individual differences at work too. So try both and follow what has the best effect. I’ve been doing it daily, twice a day when I have time, and for as long as I can manage. Really the more you do, the more the effect. But 30 minutes of 5 minutes alternating hot and cold water seems to have an excellent effect.

Next, the tendon strengthening work. I’ve been doing eccentric wrist curls which stimulate the tendon more strongly than the muscle tissue to grow. I started off using quite a heavy dumbell arrangement, but have since found it easier and more practical to simply use force from my other hand!

I’ve also been massaging the tendon and flexing it under no resistance. Finally, I stretch it probably 30 times or more during a rock climbing session (i.e practically between every route/circuit/problem).

I’m finding that the combined attack on the injury seems to be creating a strong enough reminder to kick it’s lazy ass into making a bit of progress. It’s still reluctant as hell though, and a week off due to illness has been enough for the elbow to let me know it’s missing the TLC during training!


Jolli said...

Hi Dave,
Just in case you missed it. I´m quoting my earlier post on this matter and I´m having very very strong results on this one:

"I have two solutions:

Have you ever tried trigger point therapy on your injury? After learning what´s the deal here self applied is usually best as you can do it more regularly. Has done miracles for many who has suffered from the tennis of golfers elbow.

The other thing I recommend is, well, very funny apparatus which is supposed to be used to wax cars. Like this:

It´s not very good in that purpose but for five years it has been the absolutely best machine to treat different recuperative issues for me and many others I´ve recommended it to. Being them climbers, powerlifters, swimmers, footballers etc...

The action is that it vibrates VERY strongly once applied next to skin (or shirt in between) and the relaxing effect is much more intense than in sports massage.

Again Dave, I´m not joking at all. I´ve been a strength coach for many sports for almost 20 years and this is the single best thing I´ve ever met in this area of action.

Some very experienced sport docs, therapists, ostheopaths etc have been quite amazed when asked to try this strange machine. Usually after that they have taken it to use themself.

Feel free to ask more. Cheers!"

Fiend said...

I concur with your post Dave. I had a persistent golfer's elbow injury in 2008, and found those techniques you mentioned to be the most effective for improving it.

Also warming up very well (e.g. a quick run) before climbing, and doing pressups regularly too.

Jolli said...

There has been also quite promising studies on the effects of excentric training on the achilles tendon too few years ago. I´ll post a link if I find it.

The main effect is that excentric training makes more "damage" on the tendon and muscle than concentric itself so the repair and supercompensation is also greater.

It does not "target" tendons that much more as tendons and muscles are connected and working as one.

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Allan said...

Hey Dave.. Ive left a few comments on your pages before about climbers elbow. Thought I'd share my experiences as I have probably alot more than most people. I have no medical training, only two years of tendonitis to go upon.

Ive had problems with nearly all the tendons in my forearm and even up into my biceps.

First of all, make sure you know what tendon is injured, tennis, golfers, brachialis (bicep and forearm) and also my gf has it in her bicep tendon (outside of the bicep). So I think its quite important to work out what is actually injured (best way to check is applying pressure in the area's that hurt and you will soon feel a very tight tendon and pain)

Professional help is great but will only get you so far, you really have to committee a good part of your life to rehab on your own. Dave's advice on rehab is something you really have to install into your whole life, not just climbing or spare time. Id suggest seeing a proper Physio and go from there, here in NZ Physio was free under government healthcare, so I've had my fair share of appointments and treatments.

Ultrasound... Ive had alot of ultrasound and to be honest I never noticed an improvement. Not saying that it doesn't work, I just don't think it will work on its own.

Acupuncture, I'd really recommend acupuncture but you must find someone who really knows what they are doing. I was lucky to have a lecturer at the local college do mine and she was amazing. I think once a week in the first months will get you along way to recovery but on its own, not the cure. (I had the modern electro acupuncture therapy and trigger point massages)

Dave's Ice bath..... well I found the best and fastest gains here. Two sessions (over two days) of just ice and the tendon really felt "loosened". I have problems on both arms so used one arm as a control and only treated the other (probably a good idea if you are the same and want to gauge what is working and what is not). I have used a heat bag as well on its own and haven't seen the same kind of gains.

Now heres the real advice... none of the treatments above will get you anywhere without sticking to a proper weight and stretching program. Dave's advice on a full mind body and soul rehab is what's gonna get you through this. This isn't a do for three week thing and hope it goes away, its a for the rest of your climbing life thing, every day, without fail.

I do wrist curls, finger curls, tricep kickbacks and the hammer twirls (not sure of name but I think its on Trainingforclimbing.com website under injuries). I use a 3kg and 4kg weight, all of the above is three set's of 10... now I do three set's of 15.

I did this routine daily for two months and was able to start climbing again painfree, Climbed for three months like this although I wasn't as strong or couldn't train as hard as pre-injury. Then did a four month road trip (no weights) with only one flair up from driving a car between crags... Took a month off at my half way point and it came right (no weights here either) where I was able to climb for another two months. I then entered a gym boulder comp once I got to my new home and perhaps went to my limit and beyond (hardest I'd climb in a very long time) and really set my elbow's off. I got lazy and didn't really keep up with my weight exercises, typically, "She'll be right" but my problems didn't go away and perhaps even started getting worse.

However the best form of rehab is prevention. Don't over train, I know climbing is alot of fun but trust me, one days climbing isn't worth two years so far of pain. I knew deep down I needed to rest but ignored it and kept climbing.

Anonymous said...

What stretches do you use for an elbow?

Jordan said...

Great article! very informative. I have a quick question related to your article.

can golfers elbow cause compression of the ulnar nerve, and even entrapment?

Eric said...

Hi Dave

I have been following this daily treatment for three weeks now and I am pleased to say that my chronic golfer's elbow in my right elbow has already cleared up 80%! I will stick with it. Many thanks for the tips.

Isaac said...

Thanks for posting on this topic Dave -- I've been battling elbow tendinosis for the past several years, and I'm always on the lookout for new treatment techniques. Like many others, I've found that even after becoming pain free, I need to be careful to avoid flare-ups (and they still do occur). I thought I'd share what treatments have helped me over the past few years:

- Warming up I've found to be very helpful - before climbing, before treatment exercises, and before stretching. Ideally something that increases heart rate and breaks a light sweat; if I'm just doing some quick stretching I'll do wrist exercises (wrist rolls with open and closed hands).

- Stretching: I try to do these at least several times a day, regardless of how much I'm climbing. I stretch both flexors and tensors. http://www.nicros.com/archive/climbers_elbow.cfm

- Eccentric wrist exercises: I originally used dumbbells, but have now switched to a rubber bar, which I discovered after reading a NY Times article:
I also do the pronator exercises (shown in the stretching article above) as well as push-ups (press-ups) before and after climbing.

- Omega 3 Fatty Acid: before and after climbing workouts I try to consume increased amounts of omega 3 - from fish (mostly salmon) when I can get it, otherwise eggs (enhance with omega 3) or as a last resort, fish oil pills. In my experience this has been very helpful at reducing frequency and intensity of flare-ups. Do a search on "omega 3" and "tendons" for more info.

- After a flare-up I'll typically try to take a week or two off from climbing to let the pain recede, while concentrating on the above methods. Then I'll gently start back into climbing, but only once a week or so for the first couple weeks, and only easy climbing at first.

Anonymous said...

Hi Dave,

As a therapist and climber, interested in climbing injuries, for the upper limbs problems just to say, it would be good to check your cervicals (osteopath - chiropractor). From there emerge all de nerves that plug in all the tissues. They also can be damage and tender. With a poor or distorted information coming up and down by the nerve the muscles and other tissues innervated by them not respond in a correct way giving an overload and at the end damage. Its just a point of view, sometimes works.
Its also necessary check all nerve's traject for tension and entreapments (neurodimaics) and work the myofascial chain involved (anatomytrains) and elbows block joints (osteopath - chiropractor).
Well, there are other things also, but these are some tips beyond topic muscles and tendons

For streching: Aaron Mattes Method, it gives an interesting neurology approach.

Sorry for my english is not my first language.

Nice web,