QUESTION: I’ve been climbing for five years and in the last year have experienced considerable elbow pain around the medial epicondyle. I went to see a specialist who suggested I have PRP (platelet rich plasma) injections. They are rather expensive and even he didn’t sound convinced they’d work. Is it worth trying?
THE DOC SAYS: Unfortunately, medicine is not just about your health—although I think most practitioners start out with this altruistic approach. Market forces affect virtually everything in life, and medicine—because practitioners are typically big earners—is subject to the market, too.
The invention of the hypodermic needle revolutionized not just the delivery of medicines but categorically shifted what could be achieved—and very quickly. But injectable therapies for tendon pathologies are essentially the bastard child of financially driven medicine and human psychology. People will usually try (and buy) a solution before doing any work themselves.
Autologous blood injections were the first iteration of this style of therapy and were proffered as the new great hope for people suffering tendinosis. Pushed hard in the 1990s, they have since floundered behind the next new great hope, PRP injections. Prolotherapy entered the fray around the turn of the century but never really got its legs, probably because the injection of blood products sounds way more fancy than that of sugar or saline solutions.
What little evidence there is for PRP in the general-research cosmos is feeble and fraught with methodological anomalies that would make a black hole envious. Medicos may argue that public application of experimental therapies is all part of the great epidemiological study known as modern medicine, but I would argue that the period of “guinea pig research” ended a decade ago at best. Move on, people.
PRP is medicine for the lazy or desperate. If you have money to burn, I suggest you just burn it at home and save yourself a trip to the doctor.
QUESTION: I recently had elbow surgery to remove some debris in the joint, though I have not had any major elbow injuries. How did the junk get there and, now that it’s gone, what can I expect?
THE DOC SAYS: Well, you’re not suddenly going to become the next Alex Megos because those bits were your personal Kryptonite. One-arm chin-ups will still be prohibitively hard.
You first need to give that elbow a month to recover from the surgical incision, as the doc will have sliced into the joint itself. If the surgeon has only irrigated the joint, then recovery and return to climbing should be pretty quick. The real question is why is there shrapnel in your joint? Where has it come from and how much damage is associated with its origin?
Typically, debris in the elbow arises from damage to the synovial cartilage surface. Acute trauma can lift a chunk out of the shiny surface—known as synovial cartilage—in the joint much like a wedge to a putting green. That piece of cartilage, bathed in nutritional synovial fluid, lives on as a vagrant inside the joint. Chronic load can also cause degeneration of the synovial surface, resulting in small pieces breaking away
At some point in years to come you might develop arthritis. It’s actually likely, but not a given..
If you have had a significant cartilage lesion, then the outcome will be tepid at best. Although your elbow may be less aggravated in the following months—and any locking of the joint is also likely to be alleviated—those cartilage “scabs” will make themselves known as surely as nepotism in the U.S. political landscape.
There is certainly something to be said for joint strength and stability when it comes to slowing joint degeneration, but at some point this benefit is mitigated and the same exercise will accelerate the degenerative process. Anything other than moderate recreational climbing is probably overstepping your bounds.
You could train and climb hard again. At some point in years to come you might develop arthritis. It’s actually likely, but not a given. Add the factor of mental health and there is a pretty good argument to resume business as normal. If your elbow becomes aggravated, then you are going too hard and you need to back off.
This article was first published in Rock and Ice No. 227. For over 3,000 stories, articles and wisdom from experts including Dr. Julian Saunders, go to www.rockandice.com