Common climbing injuries - elbow injuries
Elbow pain can be caused by inflammation of the long finger flexors of the fingers where the tendons join in a common origin onto the inside of the elbow - called 'Golfer's elbow' or 'Throwers' elbow.
- Aching or sharp pain in the inside of the elbow or down the inside of the forearm
- Pain on gripping, or on holds for climbing
- Can be sore initially, ease off but then return as you do more
- Tender to touch around the inside of the elbow and/or just below
- May be painful on stretch of the muscles
- A change in climbing activity
- An increased intensity, duration or frequency of training
- Changing from indoor to outdoor climbing
- Changing from one discipline to another e.g. sport climbing to bouldering.
In the acute condition this is due to a sudden excessive contraction of the flexors of the wrist and fingers, in the chronic it is due to repetitive activity, which leads to the damage of the tendon fibres.
Other contributing factors may be tight muscles, spinal problems, muscle imbalances and nerve related problems, but it can also arise from:
- The joints, nerves or discs of the neck or upper back
- The elbow joint
- Irritation of the ulnar nerve as it passes through the 'funny bone' the groove on the inside of the elbow (ulnar nerve entrapment)
- Partial or complete tear of the tendon where it attaches onto the bone
- Strain of the ligament (medial collateral ligament)
- The tendon pulling off part of the bone (avulsion of the medial epicondyle). This is more likely to occur if you are still growing
- A fracture of the medial epicondyle
Changes in intensity, duration of frequency of training, or switching from one discipline to another could be the problem
A full assessment is required to exclude other causes of the pain and to clarify the problem.
- Reduce your intensity and load of climbing
- Stretch the upper back, shoulder, elbow, wrist and fingers regularly
- Massage the area prior to climbing and apply ice as soon after as possible (to reduce cell damage)
- Ask your general practitioner (G.P.) about anti-inflammatory drugs.
- Seek out a sports practitioner if your problem is not improving over five to seven days
- Treatment may include manual therapy and electrotherapy to improve the quality of the tissue and to settle the inflammation in the local area of the tendon.
- Soft tissue release techniques may be required through the forearm and hand, not forgetting further up the chain through the upper back and shoulder
- Mobilisation of any joint stiffness secondary to tight soft tissues.
- Mobilisation of the nervous system through the soft tissues (neural mobilisation)
- Progressive programme of stretching exercises specific to tightness,
- Re-education of muscles and movement and
- Strengthening exercises to regain fully loaded function and graduated return to climbing.
- The exercise programme will be defined from assessment and progressed according to signs and symptoms.
- Postural issues may also need to be addressed to ensure long-term success, particularly in the chronic condition.
If treated early (as an acute injury) and any underlying problems are addressed, be they musculoskeletal or training issues, you should expect a good outcome over several weeks dependant on the severity of the injury. However, if the injury is ignored and allowed to become chronic it could take months to resolve.
In the chronic condition it is very important that you understand the problem and its underlying causes, as incomplete rehabilitation is rarely successful. It is far better to have a few more weeks without climbing, in order to make full recovery than to resume activity before the injury is fully repaired and end up with permanent damage.
- Avoid overtraining
- Progress intensity, duration and frequency of your climbing steadily. Particularly, take care after a period away from climbing (even if it was not due to injury), as your tissues will quickly lose the strength and resilience gained through regular training.
- Be sure to warm up and stretch effectively, pay particular attention to your wrist, fingers, elbow and shoulders.
- Regular massage of the upper back and arm can be helpful.
- Allow regular down time for rest and recovery of your tissues.
Alison Macfarlane is a Senior Lecturer in Physiotherapy at Sheffield Hallam University and a private practitioner at Hallamshire Physiotherapy Ltd
. She has worked in sport for over 30 years and has worked with many national governing bodies including United Kingdom Athletics (UKA). She was also the physio for climbing Team GB. Her specialist area is the rehabilitation of sports injuries.
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