How to Fix Tennis Elbow for Climbers (Outer Elbow Pain, Lateral Epicondylitis)
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- Опубліковано 3 чер 2024
- For more content like this as well as in-depth blog writeups and links to research articles, go here: www.hoopersbeta.com/
More elbow!! We keep it rolling this week as we take a look at the lateral elbow and dive into lateral epicondylalgia. We talk about what it is, some brief anatomy, mechanisms of injury and risks, testing, and finally, treatment.
(00:20) What is Lateral Epicondylalgia?
Lateral epicondylalgia is an irritation of the lateral elbow, in climbing this most often means the extensor tendons. Most of us know this lateral elbow pain as lateral epicondylitis, but this is misleading. Lateral epicondylitis infers that there is inflammation of the tissue, which occurs with acute injuries. Lateral epicondylalgia is more of a chronic issue and, rather, infers to a dysfunction of the tissue. It most often is referring to disorganized tissue and neovessels within the involved tendon. The neovessels within the tendon can cause an accumulation of fluid around the tissue which makes us believe there is swelling, which we may mistakenly infer to be inflammation. The disorganized healing aspect is really important in helping us understand what to do to treat it.
Anatomy: The two most most commonly affected muscles of lateral epicondylalgia are the Extensor carpi radialis and the Extensor digitorum. This will matter when we look at our treatment as well as our testing.
The extensor carpi radialis is responsible for wrist extension coupled with radial deviation, whereas our extensor digitorum is going to function to extend the fingers.
(01:02) Risk Factors and mechanism of injury
Repetitive or explosive athletic movements involving eccentric motion, in which the muscle-tendon unit is lengthened while contracting, may increase susceptibility to injury
Performing strenuous or exaggerated movements with degenerative or disorganized tissue further increases the risk of injury (As in, when you’re injured, you need to stop injuring the tissue further)
Work related: repetitive movement for at least two hours daily, forceful activity (managing physical loads over 20 kg)
Then, there’s the obvious…. Activities that include excess activation of these muscles without allowing for rest (e.g. rock climbing).
(01:38)Signs & Symptoms: Pain over the lateral elbow which is increased with active or resisted extension with the elbow and wrist in full extension and/or with passive stretching into wrist flexion with full elbow extension
(02:25) Testing:
Note: positive for epicondylalgia = reproduction of pain / familiar symptoms
Mills passive stretch
Cozen's Test for extensor carpi radialis
MMT at 3rd digit for extensor digitorum
Grip strength testing: if you are afflicted with lateral elbow pain you may not only experience pain with your grip strength but may also experience weakness.
Radial Nerve Entrapment Explanation (05:45)
Note: your symptoms may also be coming from the cervical spine so if you have a history of neck issues you need to see a specialist to rule this in or out.
(06:36) Treatment
- Soft Tissue Mobilization: since the tissue is disorganized, manually manipulating the tissue can be effective in helping the tissue, particularly as it is remodelling. Studies have shown that an external stimulus to tissue can help with the organization of the tissue, which allows the tissue to heal with better cellular structure which may lead to improved tensile strength.
- Exercise/eccentrics: slowly elongating the tissue with a load has been shown affected in many places in the body. The goal is to help the healing tissue while building strength to improve the tolerance to the activities that we perform. If you add a hold for ~5 seconds at the top of the movement, you can also help displace some of the inappropriate neovessels that are causing the increased swelling around the tissue.
- Bracing can help particularly if you have a risk factor of repetitive movement for at least two hours daily with your work.
- Activity modification: pay attention to your training program, climbing style, work, etc. Modify the behaviors appropriately to reduce the strain and stress you place on the tissue.
Thanks for watching and reading! Make sure to check out the two part wrist stability program in our other videos to see good overall wrist training.
Reminder, any exercise shown in this video are to be performed at the user's own risk. This information is not meant to replace direct medical intervention and if you have serious concerns you should seek professional help immediately.
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For more info visit RockTherapyPT.com
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Jason Hooper, PT, DPT, OCS, CAFS
Filming and Editing by Emile Modesitt
www.emilemodesitt.com
Instagram: @emile166
Special thanks as always to The Wall for letting us film! @thewallclimbinggym - Спорт
Passed all the tests I guess I’m just sore af being a new climber
I just found your channel and your videos are incredible. Thanks for your job!
Just found this video and has been more informative than anything else i've read or watched. Felt pain and extreme discomfort from the radial nerve tests and without this video I would not have realized this. Thank you.
Awesome to hear! Proper diagnosis is crucial and I'm happy this video helped.
I've been battling lateral epicondylitis (tennis elbow) in my right arm for a year. Just yesterday I read ONE line in Dave McLeod's book Make or Break that I think will help. He suggested that the majority of tennis elbow cases in climbers are not caused by climbing, but by chronic tension through the day. All in the last day I realized how tense my wrist extensors are all of the time because of how I use my phone and computer with my right hand. I thought it was all caused by climbing, but I can see now that climbing merely showed how stressed out I had already made those connective tissues over the years. They could handle my device use, but they had become to worn out for climbing.
This has already been so illuminating to simply be aware of chronic tension in my right wrist extensors! I searched far and wide for a solution within the climbing realm, and watched this video as if it's gospel, but never realized that climbing/training has nothing to do with it. Gotta say it's disappointing that you don't mention this obvious little fact in this video. If you had, I would have been saved a lot of pain in the last year and probably would have climbed a lot more. Dave McLeod is the best!
This video is very helpful. Thanks.
Currently struggling with climbers elbow for a while now, would love to meet up in person and get a check
This is really good material information. I like many climbers have suffered from both lateral and medial elbow tendon issues off and on for decades. I am now in my 60s, and have no plan of quitting climbing. I am presently sporting one of each (lateral left, medial right). These eccentric exercise techniques along with self tissue massage with a tool and maybe some of the stretching shown in your entrapment video are very long term scalable.
I would love to hear your perspective on Prolotherapy treatment, either with an irritant, like Sarapin, or the more modern platelet rich plasma (PRP taken from the patient prior to treatment). I did this once a few years ago, and was largely happy with it, except for the cost (~$900 out of pocket at the time). It is also pretty painful on day 1 &2 and week 4 seemed to feel like it was a mistake. However, by week 8 on it was better than it had been in years.
Super helpful! many thanks!
Risk factors: climbing (poor technique, lack of rest, extensor weakness), repetitive daily tasks, consistent heavy lifting (20kg+)
Pain Provocation Tests:
1. Mill’s test (2:41)
2. Cozen’s test (2:56)
3. Extensor Digitorum test (3:16)
4. Grip Strength test (3:51)
5. Radial Nerve Test (4:30)
Treatments:
1. Activity modification (6:45)
2. Tissue mobilization (7:18)
3. Bracing (7:52)
4. Eccentric strengthening (8:07)
Wow!! Thank you so much.. started to have outer elbow pain and now I'm doing everything to heal it.. Superb info!!
Hopefully it is starting to heal up nicely!
@@HoopersBeta it is a lot better, thanks!!! Working the tissue with the end of a butter knife really helped 🙏
Just what I needed
Thanks, Doc. Radial nerve entrapment.. The numbness traveling is obnoxious. Starting treatment today.
What a great video
I tested positive but really really mildly, so thinks weren’t painful but I definitely noticed some kind of difference and pressure in tendons/elbow.
Really glad I came across this channel - great content! Hopefully this comment reaches you! After successfully getting rid of lateral epicondylalgia before lockdown, I had it flare up again once I could get back in the gym (couldn't resist getting psyched with all my lockdown strength gains and trying really hard every session... silly me!). While going through the rehab process again, it got me wondering - could using various grip attachments (like fat gripz or circular grenade grips) on my dumbbells be beneficial when carrying out the eccentric movements? Interested to get your thoughts on this.
Sorry to hear about your repeat injury! But yeah, absolutely. The different grip may cause different muscle length-tension relationships, or may even affect the firing patterns to work different muscle groups more depending on the grip. Do what ones feel best to you! You may need to consider them as separate exercises, though, if it creates a large difference in the force creation you feel. Happy you found the channel as well ;)
These kind of videos are the best of this channel and most of UA-cam rehab content. What about a plantar fascitis one, Doctor?
Thanks for the kind words! Unfortunately, that's not an issue I see often enough in climbing for it to warrant a dedicated video (though I do see it in my practice for many other sports!). Regardless, I'm sure there are other great videos out there that could give you some information on it!
Thanks so much for your videos, have spent quite some time between PTs and doing my own research (it seems inevitable with climbing-related elbow injuries) on how to restore proper function in my elbows. Reassuring to know that eccentrics seem uncontroversial. Quick question - to what extent is the pain of lateral epicondilytis supposed to be localized on the epicondyle? I often feel it rather towards the forearm, or sometimes in the opposite direction - on the olecranon. For the lesser-initiated, showing etiological aspects with your sleeves up will be a great help! Please keep making the videos!
Lateral epicondylitis refers to an irritation of the tendons that insert at the lateral epicondyle so in a literal sense is should be direct there but general tendinopathies can absolutely be felt more towards the forearm at the musculotendinous junction. More towards the olecranon could be referred pain or just another muscle issue. Proper diagnosis sounds key in your case as there may be more than 1 muscle involved!
Well, thanks for this very good video, sir. Appreciate this. None of these tests causes me pain so I guess I have starting stages of some tendonitis/student elbow pain... including all factors, weak shoulders (can´t do handstand push up yet) lot of straight arms exercise, one ar chins, handstands, ). Elbow hurts when touching table etc.. I have small inflammation, but not red..I use supplements D, omega, collagen do stretching stuff, mobility from dozens of elbow pain calisthenics vids, i stopped my training routine and do mostly legs and core now, also i use some ibalgin, cold oinments + imma using support trap..Any tips plz. Thank you so much sir
7 weeks into climbing now and im still battling tennis elbow. I think the eccentric loading and massaging is helping, but one thing in this video has bugged me. Jason says that massaging the bone will do no good. But since bone is where the tendon attaches, then the part of the bone that hurts will actually be the tendon and therefore the most important place to massage. It seems like the only way this wouldn't be true is if the damaged part of the tendon refers pain to the undamaged bone. Is this true? At any rate, please do more videos on elbow anatomy with respect to climbing! You guys are awesome, keep up the good work!
For me what I've found to give almost immediate and lasting relief is massage of the trigger point in the triceps. If you find a tender spot in your triceps this will most often be the cause in my experience and massaging that spot completely alleviates the pain in the elbow. Hope that helps someone.
Can you clarify exactly where one would experience pain during the respective provocations tests. Thanks!
Thanks! Yeah my elbow hurts a lot when I do things like throw a ball for awhile or play ping pong. That movement makes it worse.
What kind of weight for eccentric exercises? And will massage gun be okay for mobilising tissue?
Iv started getting this, my job is removals and Iv never had this pain before climbing, but I’m very new and yes I don’t rest that often lol but man when the pain hits it’s hits haaaaaard! I can literally only do about 3-4 moderate problems and then I’m out 😅 it’s a horrible pain and kinda annoying because it really limits your fun bouldering
Thank you!
You're welcome!
My pain seems to be right where my tricep connects to the back of the elbow in addition to the lateral/outer elbow, would these exercises also apply or is my situation different since my tricep is involved. I got an extreme burning sensation in my elbow one of the first times i tried bouldering and it seems no matter how much time i take off and rest up the pain eventually comes back after a few sessions as i try more demanding climbs. One time I was pain free for weeks and triggered the pain the day after a climb while trying to take off shoes that were very tight by using my arm to push the heel part of the shoe off lol. Also none of the tests mentioned in this video really irritated my elbow. Any quick tips/advice?
Thanks the timing of this couldn't have been better for me :) I just started some rehab pretty much as you suggest + icing. Should I be icing the area? If so how long and how often?
Glad we have good timing! To be honest, ice massage can feel great and be effective, but unless it is truly an acute injury the icing aspect isn't very effective. The pain you may be experiencing (if not very acute) is more of a pain response due to the neovessels in the tissue which cause discomfort and swelling as those neovessels are hydrophyilic so they attract water. But, the ice "massage" aspect can help to reorganize the tissue and over time can help with the tissue remodeling (while also feeling nice because the ice can reduce the discomfort).
@@HoopersBeta Can you please clear up this text for me. Is icing just/mainly effective at the begining or is it better to wait a little bit?
My english isn't that good and I'm not sure if i get it right. Thanks
Hello Hooper! Thank you SO much for this video, exactly what I was looking for!! I need your help on something.. I climbed way too hard last year and injured my elbow, and pain has been going on for more than 6 months. I unfortunately did not rest early on, and it was only in the 2nd-3rd month into the injury when I realized I had to do some rehab and therapy on the elbow. My questions:
1) How does weather affect this injury? It's winter where I live now and it hurts everyday, but when I went on vacation at a tropical country, I noticed it hurt much less.
2) Does the time between actual injury and rehab affect the growth of 'straight'/well connected tendons in the elbow? It's been 6mos for me and I'm only starting to do eccentric exercises now, a bit worried that I'm strengthening a messy version(?) of tendons in the elbow
3) I've tried physical therapy in different hospitals here in Korea but they didn't seem to work. Do you have suggestions for specific professional treatments injured people can look for or mention to clinics that aren't familiar with climbing related injury?
Hope these questions make sense. Would appreciate your help. And thank you for the great content!
I am happy that you are finding our channel helpful! Sorry to hear of your injury, although.
1) the first question is an interesting one to answer because it involves many perspectives. Some are physiological, and some are psychological. From a purely physiological standpoint, colder temperatures can cause muscles and tendons to tighten, and that tightness or, better, rigidity, can cause pain. A drop in barometric pressure can also cause there to be differences in swelling at the joint which can produce pain. These small changes can lead to a psychological impact as well. We then feel the pain, so we are focused on the pain, and when we focus on pain it is easy to find it and enhance it. If it is warmer and the muscles are less rigid, and we are on vacation, we may not have that reminder of pain and we will not be paying attention to it simply because we have other more important (or fun) factors to focus on. It gets much deeper than that but that's a start!
2) Yes, your healing timeline does matter. Most of the healing of damaged tissue (just being general, not implying your tissue was damaged) happens between 2-4 months, and is greatest between the 3rd and 4th month. So if you were not properly rehabbing, you may have tissue that healed more "haphazardly", BUT, that doesn't mean you cannot still perform eccentrics to strengthen the tissue and help promote proper cellular structure going forward.
3) Tough! If they are unfamiliar with climbing then they may not understand the stress/strain on the body, but if you can find an PT who is an OCS (orthopedic clinical specialist) or an OT/PT who is a CHT (certified hand therapist) they can offer you more advanced treatment options.
Thanks again for watching and help us out by sharing us with your friends!
Cracking video mate, got the theraband on the go but not using it nearly enough based on your guidance so will step up my sets and reps. How do I know whether I should be using the medium strength or high strgnth flexbar?
Thanks for the comment and question! Typically, you can judge based off of the time/reps to fatigue as well as pain. If you are using the high strength flexbar and it is causing pain, back up to the medium. If the medium isn't producing any fatigue after 12 reps? You need to step it up. Typically, I am looking for fatigue (muscle burn) from an exercise between 8-12 reps (sometimes extending that range to 6-14 depending on my goals).
@@HoopersBeta Thanks for taking the time to reply!
im feeling the last test HEAVILY HEAVILY in my outer muscly side of my forearm, but its fine in my ellbow, what does that tell me? im rather having ellbow pain on certain tricep movements. i mean post lockdowns i restarted hitting the gym 4times a week and 1 extra time bouldering ( i started bouldering 5 weeks ago). is that something different?
i am trying to stratch both forearm muscles just as the hand ankle and biceps triceps - but doesnt really help
Thanks
Thank you!
Thanks!
thanks so much! :)
Hi, thank u so much for the video. Ive been going with escentrics for 2-3 months now. What about climbing ? Can u still climb ?
What about other excercioses as pull ups or push ups ?
Thank u so much
In general you want to avoid activities that cause exacerbation but if you can climb without pain during or after that's ok!
Great videos! I have a question. I am currently training to be a firefighter. The tests include climbing a rope (no feet) and pull ups. There is a lot of loading on these training sessions (added weight and short breaks) and I get pain around the bicep area just above the elbow but it usually stops in a couple of days though I'm worried it could lead to some sort of tendinitis or something. Is bracing recommended for these training sessions? should I just work on strengthening the forearms?? any suggestions? I have cut my climbing down to just once a week so I don't think I'm loading much there. Would love a bit advice!
No advice for you buddy
Thanks a lot for all your videos!!! But which exercises exactly would you recommend to fix the issue? is there a video i did not find?! the only video with exercises is the "Climber's Elbow: What it is and how to treat it" - video.. but that one refers to golfers elbow i believe.
I had insane elbow pain for a really long time. What helped me was forearm training. I took up forearm training after seeing Jeff Caveliere (athlean X) talk about how unbalanced / weak forearms can be a cause of elbow pain. It changed everything for me.
I specifically train the forearm extensor (which from what I have researched is usually a weak muscle in most people causing unbalances)
There's a website that gives away a tool to train it (for free), www.forearmfreaks.com/free
Best decision I ever made, I wish you best of luck!
@@adderrrr3 thanks!
Can anybody help with my issue. I am a crossfiter and get the pain everytime I do legless rope climbs is this the same? If so what am I doing wrong? How do I fix it and how do I get better! Thanks
Hi, I have inner elbow pain (both elbows) rather than outer elbow pain, but I still decided to try your radial nerve test. The test reproduces the pain in my inner elbow, and in the forearm near the elbow. Moving my head to the one side and then the other aggrevates/ alleviates the pain as you said it would. I don't have any pain or numbness or weakness in my wrists or fingers. Do you have any suggestions what this might be, or further tests to try and understand what this is? This has been bothering me for months and any help would be greatly appreciated
Oh dang, interesting findings! The first thing I would try if I saw this in practice would be to flip the wrist around and do the median nerve testing and compare this to your findings with the radial nerve testing. If the median test reproduces your symptoms to a higher degree, it may be a median nerve entrapment that is bothering you. If it reproduces them to a similar level you may have neural tension created up in the chain, and may have a brachial plexus issue. There are more tests that can be done but hard to explain in text heh. But I would definitely start there and see what you find!
@@HoopersBeta by flipping the wrists do you mean palms facing forward? If so, then I'd say it's the same intensity
@@HoopersBeta I've had median nerve pain before, and the physio sorted it out quite easily. This time it feels more to the inner side of the elbow (I guess near the ulnar nerve if I look at diagrams online?)
@@joestoker7340 the median nerve tension test is quite different than the radial nerve test, though, which would not make me immediately think ulnar nerve. It's worthwhile for you to look up ulnar nerve distribution as well as an ulnar nerve tension test to rule that in or out, although.
Hey Hooper! I did all your nerve entrapment tests. Felt nothing. But than when I iced my elbow I felt nerve pain from my elbow all the way down into ring finger, pinky, and some of my middle finger. Burned a bit while my ice pack was on and when I took it off I felt like my arm went to sleep. I googled it and it sounds like ulnar nerve entrapment. How is ulnar nerve entrapment different from radial nerve entrapment?
The distribution of your symptoms certainly present like ulnar nerve, have you tried the ulnar nerve tension test to confirm? Radial and Ulnar nerve entrapment vary in the location. You can have an ulnar nerve entrapment in your hand under the hook of the hammate / guyons canal, at the elbow known as cubital tunnel syndrome, or even up in your thoracic region with thoracic outlet syndrome. With the radial nerve, the entrapment is much more commonly at the elbow and is on the lateral aspect whereas the ulnar is the medial/posterior aspect. They are, most often, very different pathologies and should be treated as such. The big aspect is finding where the entrapment is occurring as this will significantly change the treatment plan. Hope that helps answer your question!
Thanks Hooper! You’re awesome dude. I send a lot of people to my guy in SLC, I’ll send them you’re way too now. Also, nice to know I’m on the right track. I’ll try and distinguish which issue it is. Climbed for like 4.5 hours today and sent my project. No noticeable weakness in fingers or forearm, so I’m wondering even though my ring finger and middle finger feels a little numb does it even matter? It didn’t hurt at all while climbing. It just hurts when I’m resting.
@@Schyluer thank you! I appreciate the vote of confidence.
I would still definitely say yes, it does matter. You don't want it to progress to an entrapment that does end up causing any weakness. It may not progress any further 🤞 but better to not risk it. the pain after you stop climbing could be due to increases in interstitial pressure since there's less muscle contraction to keep the fluid moving, or just the muscles tightening up around the nerve. Also, congrats on the send!! 👍
I have chronic pain originating in the same place on the outside of the elbow, but none of the pain triggers did anything to bring it out. That is despite me feeling the pain at all times on its own.
Are there any other possible causes ? The pain has gotten debilitating enough, that I decided to stop climbing until it is resolved completely, as it has been 3 months now and I can't seem to get rid of it. Some evenings after climbing I had to resort to taking a NSAID to allow me to fall asleep, even...
We have a video about nerve related issues. If the pain is on the outside of the elbow you might want to look up radial nerve issues. If that doesn't help, I would recommend seeking advice from a skilled medical professional.
Hey! Thank you so much for this video. I have a question... should i stop climbing all together while i work on tissue mobilization/eccentric strengthening? Like- if i keep climbing will my injuries get worse? Or is it more of a pain tolerance thing? I developed the Lateral Epicondylagia after 3-4 months of climbing exclusively on the Moon/Tension Boards and the pain got pretty severe, sometimes going down into my fingers. Thanks again for the great information!
Often a part of the question for solving a tendinopathy is removing aggravating factors. So, while you may not need to completely stop climbing, you may need to reduce the intensity for a bit while doing the other rehab exercises.
Just stop for like a year. If it keeps getting worse stop longer. It can take a long time but if you eat well and work SLOWLY but steadily on Mobilization/eccentric strengthening before returning to the job or activity that caused it.
@@travissoff9521 no, you should never have to stop climbing for a year while treating an injury.
@@alexgalays910 even if you can't hold a glass of water.
@@travissoff9521 Sure; You won't be able to climb for some time even with the best rehab in the world, but 1 year is very extreme.
I am also wondering if I should use NSAID cream(diclofenac)?
It wouldn't be my first line of defense. It will cover up symptoms. It is used in some literature but I'm not a fan (see my video on anti-inflammatories lol)
Maan my forearms feel aways pump. Doctor give me NSAIDs but didnt helped what shoud I do
Ah the wonders of being a climber over the age of 30. “Oh this hurts, well time to fix this.” “Ok that area is healed and nice. Oh what is this a new place that hurts and needs attention? Great!” Feels like I’m halfway of becoming a physiotherapist by just fixing all my own problems 😂
I've definitely met many patients over the years that have done a great job of acquiring knowledge and helping treat themselves after acquiring numerous injuries! It's fun to see, actually (as long as it's done responsibly, of course hah). But that's actually how I reframe injuries as a positive. It's a way to learn more about your body, the reason it got injured, how it can/will recover, and hopefully some insight along the way for how to prevent it again in the future :)
I think I fucked up …. I injured my elbow about 2 days ago while climbing . Didn’t felt nothing after a day of rest and went back to climbing now my elbow hurt twice more ….. now am out for a week or two.
Yeah sounds like too much too soon! Patience is one of the hardest things to learn but honestly is like a skill in the athletic / training / climbing world! Hoping you have a fast recovery.