12 October 2013

The individuality of injury treatment

Yesterday, I was having yet another conversation about golfer’s elbow with a fellow climber and sufferer of the condition (it happens pretty much every time I go to a climbing wall or popular crag). The climber was a highly experienced and skilled ‘lifer’ in the sport with extensive working knowledge of physiology and sports science.

It struck me afterwards how personalised advice about sports injuries needs to be, depending on where the sufferer is ‘at’ with their knowledge and approach. I’m trying to weave this idea into my injuries book Rock ‘til you drop (now finished writing and currently redrafting).

One of the fundamental points of my book is that everyone needs to make themselves an expert in as many of the relevant corners of sports medicine as we can. I’ve provided a road map to achieve this for climbers in the book. 

However, the potential ‘weaknesses’ in your ability to successfully achieve recovery, as with performance weaknesses, are highly individual. In the discussion I was having the other day, the problem I anticipated with golfer’s elbow rehab is being too scared of the pain required for success in the rehab protocol. I don’t mean pain as in the ability to suffer. Almost the opposite. Someone with a good knowledge of sports medicine would quite rightly be wary of rehab exercises that caused any noticeable pain. Doesn’t pain mean overdoing it? 

It depends on the injury, the stage of the rehab and the individual. In the case of golfer’s elbow (and other tendonosis conditions where large volumes of eccentric loading is the rehab protocol of choice), some moderate pain is desirable. The stumbling block for an experienced climber may be backing off due to even mild pain before the loading really has a chance to work. For someone less experienced, it might be the opposite problem; they may not be sufficiently tuned in to their pain signals and patterns to avoid overdoing it.

The subtleties of tracking pain signals and adjusting both your sensitivity to them and the loading placed on the body is both a science and art. All of this underlines the need to seek out expert opinion of the highest possible quality and preferably from more than one source. 

PS While I’m on the subject of golfer’s elbow, I note that a lot of climbers are following a protocol outlined in a homemade video popularised by this article on UKC. Rather predictably, I've talked many climbers are not having success, since this protocol is appropriate when the tendon of Pronator Teres is causing the pain at the elbow, rather than the more commonly injured wrist flexor muscles. Before you use this protocol, make sure you get a specialist (i.e. Not your GP!) diagnosis to make sure you aren’t busying yourself with the wrong rehab program. 


Tolunay D said...

But if you rotate inwards, will it help with tennis elbow tendinosis?
You seem to critize here but not giving any other options?

Dave MacLeod said...

No, it won't. For tennis, you need to eccentrically exercise the wrist extensor. You should read the whole post - I do give another option. The only decent option; to seek specialist advice to get both diagnosis and treatment, rather than relying on a brief online article for a completely different condition.

KWR said...

Careful my friend. plenty of 'GP's' out there have a lot of knowledge of sports medicine. plenty of specialists are as narrowly educated as the term implies. Know your medical professional and yourself, your goals and your needs. work your story out and your questions before you show up and GO BACK if you aren't getting better.

KWR said...

Careful my friend. There are plenty of 'GP''s out there with a wealth of sports medicine knowledge AND the ability to listen. Plenty of specialists with the narrow skill set the name implies. Know your medical professional and know yourself, your goals and your questions, sort it out before the visit, and GO BACK if you don't improve.

Dave MacLeod said...

Of course there are KWR. And that's great if you happen to be lucky enough to see one. But how would one know? Not easy for most folk to critically appraise their medics knowledge. So, if it were me. I'd use my GP as a starting place rather than take the risk.