Outside Elbow Pain: The Rock Rehab Pyramid

Part one of a weekly five part series about outside elbow pain (lateral epicondylosis).

This is part one of a weekly five part series about outside elbow pain (lateral epicondylosis). View the rest of the series at Outside Elbow Pain.

Jonathan Siegrist Spain sport climbing lockoff 8c+
Jonathan Siegrist pulls an elbow-intensive move on a Spanish 5.14c.Cameron Maier

You have been climbing hard all season and are feeling stronger than ever, except for a nagging soreness on the outside of your elbow. Every time you crimp hard on a hold, you feel the pain. Even popping the cap off a celebratory cold beer hurts. What is going on?

When you climb, you are constantly overworking the finger and wrist flexors in the front of your forearm by gripping. However, every time that you grip a hold, the muscles in the back of your forearm contract to stabilize the wrist. This constant activation of the muscles in the back of your forearm can lead to overuse and injury at the origin of the muscle on the outside of the elbow called the lateral epicondyle.

The signs and symptoms of outside elbow pain (lateral epicondylosis) are:

  • Localized point along the outside of the forearm
  • Discomfort with actively extending the wrist backwards
  • Discomfort with passively flexing the wrist forward
Outside elbow pain lateral epicondylosis climbing

Although many climbers know exercises that decrease outside elbow pain, very few climbers know how to sequence and advance their injury prevention and rehabilitation programs. When I first starting writing about climbing injuries, there was very little information available. Since then, many books, blogs, social media posts, magazine articles and videos have been created that specifically address climbing injuries. Now there is almost too much information available. This abundance of injury advice makes it challenging to know exactly what to trust. Too much knowledge without a framework can slow or even halt recovery. Therefore, it is essential to have a plan when addressing climbing injuries to sequence and advance the rehabilitation process.

The Rock Rehab Pyramid is a step-by-step rehabilitation and injury prevention plan designed specifically for rock climbers. The goal of the four-phase process is to take you from the pain, inflammation and tissue overload stage to gain full mobility, strength and eventually pain-free climbing movement. It is featured in my new book Climb Injury-Free.

rock rehab pyramid

Most climbers begin the rehabilitation process at the bottom of the pyramid, which is the pain, inflammation and tissue-overload phase. Through the rehabilitation process, you will progressively advance up the pyramid. The goal is to gain full mobility, strength and eventually pain-free climbing movement. At this point, you will achieve full recovery.

Contents of the Pyramid

Phase 1: Pain, Inflammation and Tissue Overload

Uses traction and taping techniques to unload the tissues. You can perform tissue unloading for as long as it takes for your pain at rest to subside.

Phase 2: Mobility

Uses three progressive stretching exercises to improve range of motion. Each exercise can be performed up to three times per day.

Phase 3: Strength

Uses three progressive resistive exercises to increase strength. Each exercise can be performed daily.

Phase 4: Movement

Comprised of three movement advice tips and should be implemented during each session of climbing.

When to Progress to the Next Phase of the Pyramid

Once you are able to perform the prescribed exercises in a given phase of the pyramid without pain then you can progress to the next phase. Do not perform exercises if they are painful. There is no exact formula for how long it takes a climber to progress back to climbing and movement training. It is highly variable based on your injury and individual factors.

The Rock Rehab Pyramid can be used to prevent and rehabilitate any climbing injury. See the video below to learn how to navigate and use the pyramid. This article is the first in a five-part series that will focus on how to use the pyramid to treat outside elbow pain. Stay tuned next week to learn the best research based technique to address the “Pain, Inflammation and Tissue Overload” phase of the pyramid to treat outside elbow pain.

Dr. Jared Vagy is a doctor of physical therapy and professor at the University of Southern California. His book, Climb Injury Free: A Proven Injury Prevention and Rehabilitation System teaches you how to climb even stronger without getting hurt.

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