How I Dealt with Tennis Elbow
At some point in your climbing career, the act of cranking out a set of pull-ups becomes a mundane task. So it came as a surprise to me at 6:15 on a Monday morning, while doing a bodyweight pull-up, the familiar sensation of fatigue was replaced by an unfamiliar shooting pain in both my elbows. My arms lit up like Christmas trees.
This was the first time I had ever experienced this kind of elbow pain. And it seemed to come out of nowhere.
For one week I proceeded to pretend it was not a problem. The week following I started trying to figure out what to do. This resulted in the plan you see below. Between February 9 and 25, 2020 I changed how I was climbing and the exercises I was doing. I also had a five day stretch away from climbing during this period for a ski trip which may have contributed to reducing the severity of the injury as well. Over the course of February, I continued climbing, training, and largely resolved my elbow pain. In this post, I give the details on how I did it.
First, let’s start with the basics.
What is Tennis Elbow?
Tennis elbow is the inflammation of the tissues surrounding your lateral epicondyle – the bony notch on the outside of your elbow. It is commonly referred to, in medical terms, as lateral epicondylitis.
In his post on ‘Dodgy Elbows‘, Dr. Julian Saunders explain the common conditions of both golfer’s and tennis elbow. He elaborated on the differences between tendonitis and tendonosis, both of which can result in the symptoms that encompass tennis elbow.
“Tendonitis elicits a sharp pain, felt around the medial or lateral epicondyle. It tends to worsen with activity to the point that you may have to stop the session. Left to its natural course (without aggravating activity), it should resolve in a few weeks. Tendonosis, on the other hand, is a dull ache (same place) that is felt at the start of climbing.”
Since my case of tennis elbow set on really quickly and subsided quickly as well, I am led to believe that I suffered only from tendonitis (inflammation) and not full-blown tendonosis.
What Causes Tennis Elbow?
Sources vary regarding what causes elbow tendonoses. It seems that these conditions are typically brought on by overuse, and repetitive motion. Interestingly, tennis elbow is sometimes related to excessive typing, weight lifting, carpentry, painting, and ironically, golf. Dr. Saunders evaluates tennis elbow in the context of climbing.
“The classic scenario is a sudden increase in training. The muscle, having a greater blood supply, is able to increase its strength faster than the tendon, leaving the tendon comparatively weak. Further use leads to tendon damage and degeneration. “
Evaluating the cause for myself, I believe some combination of desk work with an increase in training volume in January lead to the temporary demise of my elbows.
What can you do about it?
When I asked for feedback on instagram for how you all have dealt with elbow issuas, answers ranged from flex bars to yoga to cutting out gluten. There are many ways to skin a cat, but here is what I did to resolve my own elbow tendonitis.
Isometric Hangs at 120 Degrees
These were recommended to me by Kris Hampton at the Power Company (and many of you recommended these to me on instagram as well). Three to four times a week, I completed 3-4 sets of 120 degree isometric hangs. The duration was long, about thirty seconds per hang. I used pretty big edges in a half crimp position, edge size being 25mm+.
I incorporated these into my strength routine and warm-up. Here’s a video from the Power Company for more details.
Reverse Wrist Curls
Similar in frequency to the isometric hangs, I completed reverse wrist curls three to four times per week. I used pretty heavy weight (10lbs) and used my other hand to support the movement. I performed 3-4 sets of 8-10 reps. Some argue that the sets/weight/reps don’t really matter as long as you do them. However, I have noticed that many esteemed trainers recommends that you load these heavily and I found that 10lbs was OK for me. Whatever you do, you should be getting fatigued.
These I incorporated into strength workouts or into my climbing warm-up as well.
Note that I prefer to keep the tempo a bit slower on the eccentric part of the motion than what is shown in the video below.
Related: Hooper’s Beta on Outside Elbow Pain
Ice and the Incurable Shitty Ankle
In one of my favorite pieces of stand-up ever, Louis CK talks about turning forty and his “incurable shitty ankle.” After being told to stretch for thirty minutes a day he asks the doctor “so how long will that take to fix it?”. To which the doctor replies “No, that’s just something you do now, until you and your shitty ankle both die.”
This sums up my feelings towards ice. If the doctor were talking to me he might say “Your elbows are effed up, you should do your exercises and you should ice after climbing. Forever. Period.” Though hopefully the exercises and the icing won’t go on forever, I am going to keep at it for at least a few months.
Perhaps some would argue that the ice is not doing anything, but it also does not cost anything to strap some ice packs to my elbows for a few minutes in the evening. Since the combination of these handful of protocol is working, I will probably continue icing after climbing 1-2 times per week until I feel completely recovered.
Research on Cold Exposure
Though the mantra of “Rest, Ice, Compression, Elevation” is commonly touted in the context of soft tissue injury, there is not an exceptional body of evidence to support it. That being said, it is likely because in many cases, science is actual behind practical application. Interestingly, however, in a systematic review of cryotherapy, it was concluded that it had positive effects on return to participation for athletes.
In short, I think ice works and I think it worked for me. There is at least some science to back it up, so I will keep icing.
In addition to cold exposure after climbing, I also altered my climbing sessions.
Changing my Training
After getting over the emotional hump of acknowledging my injury and deciding to climb “around it”, I adopted a new rule of thumb: if it hurts during or after the training session, it is out of the training plan.
Basically, I knew what definitely hurt my elbows during training, these activities were swiftly removed and sometimes replaced. For example, I realized that power pull-ups were not ‘elbow-approved’; however, bent over rows were. So I replaced what was painful with something else. A little different, but it got the job done.
In my first week with this new adage, I made careful notes of what hurt and what didn’t — the day before and the day after training.
An important note: tendons tend to let you know if they were okay what you did 12-24 hours later, which is part of what makes tendon injuries tricky to deal with.
Then, I proceeded to do what I could without hurting myself more. I continued to train, though it was not as much or the way that I wanted to. However, I made sure to have an attitude of gratefulness that I was still able to keep climbing at all.
I could get into a lot of minutiae on what and how I changed in my training to accommodate my whiny elbows. If you want more details, leave a comment and we can discuss below.
Additional Upper Body Static Stretching
Though my warm-up typically involves some dynamic theraband stretch with the upper body, I was previously not including very much static stretching.
In TrainingBeta Episode 71 with Esther Smith, the renowned climbing physio posits that those with both tennis elbow and golfer’s elbow could benefit from increased mobility in the upper body.
“Some people are much more prone to inner elbow problems, some people are much more prone to outer elbow problems. And even if you don’t have an active elbow problem going on, it’s these types of exercises to balance what is tight and what’s weak that I think every climber should be doing…”
Esther then goes on to list a front pectoral stretch, a tricep and lat stretch. I took this idea she introduced and incorporated it into my warm-ups and cool downs.
Based on this, the stretches I added were as follows. I did these during my warm-up before climbing and sometimes in my cool-down as well.
- Theraband Lat stretch (exercise recommendation courtesy of Unstoppable Force: Strength Training For Climbers)
- Foam roller chest opener
- High Windmills (courtesy of Unstoppable Force)
How do you move on from an injury?
As I write this, I would call myself 90% recovered. I am climbing strong and pull-ups no longer hurt. However, I am still taking care not to overdo it. My plan from here on out is to be conservative, vigilant, and continue doing what I am doing to eradicate the injury.
Have you struggled with elbow injuries in the past? What has worked for you? What has not? Leave a comment or shoot me an email at firstname.lastname@example.org, I would love to hear from you!
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Featured image in thumbnail by Teagan Maddux.