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.