What's the Best Way to Treat Elbow Tendonitis? Keep it from Starting.

This article was originally published in October, 2012.

The repetitive motions of climbing and training are hard on the body, especially when done for years on end. Our sport involves lots of pulling down and in toward the body, and the required muscles become well developed at the expense of other muscle groups. Add common daily activities, such as sitting hunched over a desk or driving, and the potential for problems gets even worse. The result? Extreme wear and tear on the elbow and shoulder joints.

But you don’t have to be doomed to a future of physical therapy. By doing this small circuit of exercises, you can help prevent and even heal elbow and shoulder injuries. You can do them daily or whenever you have a free moment—you don’t have to sacrifice a chunk of climbing time. None of these exercises requires any equipment, making them a breeze to do while reading from a screen or watching TV, so there are no excuses not to give them a go. Don’t learn the hard way and only do them after you get your first chronic injury.

Inner Elbow

Chronic elbow injuries often result from long-term degeneration of the tendon attached to the bony lump on the inside of your elbow; this condition is often called golfer’s elbow. This can be the bane of a climber’s life, especially as he moves into his 30s. This tendon directly relates to the wrist flexor, which presses your hand onto a hold, especially with deep lock-offs, and the pronator, which maintains your hand position on holds as your body moves up or twists past. (Think about crimping while turning pinky-side away from the wall and thumb-side into the wall—that’s pronation.)

Exercise 1. Eccentric Wrist Curls

Eccentric contraction means that the muscle-tendon unit lengthens under tension (similar to how your leg muscles lengthen under tension when you squat). It is key for this exercise not to load the tendon during the concentric phase (the muscle shortening or curl part of the exercise). You can use a dumbbell if you like, but it’s more convenient to press on a surface like a table edge, or even your other hand (see photos).

It may seem counterintuitive, but current research confirms the resistance in this exercise should be heavy enough to provoke mild pain in existing injuries. Bad cases will only need light pressure; mild cases may need to press fairly hard. Those with a high pain threshold will need to be very cautious and always err on the side of very slight pain. If pain levels increase throughout the workout, dial it back. You’re going too hard.

[fig. 1] With a straight arm, place three straightened fingers on the edge of the desk with your wrist pointing down (so the wrist flexor is shortened and your fingers are pointing down ). Press into the table and, while maintaining firm pressure, allow your wrist to drop slowly, lengthening the wrist flexor through its whole range of motion. As your wrist extends, you should be able to provoke some pain in the tendon near your inner elbow (medial epicondyle) if you have a pre-existing injury.

[fig. 2] Once you reach the end position with your wrist fully extended upward, bring your wrist back up to the start position—under no load—and repeat in sets of 15. Reduce the force you apply if the pain gets significantly worse as you work through sets. Eccentric contractions of this intensity are not really tiring, so you need very little rest between sets—have a sip of coffee and do another set!

For existing injuries, doing large numbers of reps (180 to 250 every day!) gives better results than doing fewer reps. Fortunately, it’s not much of an effort to clock up this sort of volume, since you can do it while sitting at a desk. It’s also a good idea to do these exercises as prevention, especially if you have experienced an injury in the past.

Outer Elbow

Almost the opposite of golfer’s elbow, the condition often called tennis elbow affects the outer elbow; the pain is caused from wrist extension. (Think about having your palm facing out, ready to receive a high five.) In climbing, you do it while pinching, crimping, underclinging, and other moves. It can be the result of anything from simple manual tasks—I got it from rigging heavy, wet ropes—to inherent weakness compared to the more heavily trained flexors.

Exercise 2: Tennis Elbow Wrist Curls

The exercise is the exact reverse of eccentric curls, and it is more easily performed with a dumbbell, heavy object, or by providing resistance with your other hand. Again, only apply the load during the eccentric phase, so if you use a dumbbell, use your other hand to pull it back up.

[fig. 3] With straight arms, turn your wrist down, rest it on your knee and place the other hand on top.

[fig. 4] Pull your wrist upward into extension by moving the back of your hand up and toward you while adding pressure with your other hand to load the extensor tendon. If you’re using a weight, simply grip it in your hand and do the same motion. If you have tennis elbow, you’ll feel pain near the lateral epicondyle on the outer elbow. Again, many reps and a little mild pain are the order of the day. Remember to reduce the intensity if the pain increases through the workout.

Shoulders

Most often caused by postural or movement faults (muscles being too long, too short, or not activating properly), shoulder injuries are very responsive to specific exercises that remove the underlying susceptibility. Climbing and much of modern life (driving, sitting at the keyboard) involve moving the arms in an internally rotated (slouched) position. The large internal rotators that move shoulders forward and in, such as the lats and teres major, become overdeveloped and tight. This puts your shoulder out of alignment, and your weak external rotators—they move shoulders outward and back—are unable to control shoulder movements and effectively balance against the strong internal rotators.

Exercise 3: Wall Slides

This basic exercise to correct shoulder alignment and movement looks too easy until hunched, muscular boulderers try to do it. It stretches the internal rotators and promotes good activation and alignment of the entire shoulders.

[fig. 5] Stand with your back resting against a wall, feet three inches away from the wall and shoulder-width apart. Extend your arms upwards over your head. With elbows locked and arms pointing vertically, try to hold your arms flat against the wall. Most women will wonder what the problem is, while male boulderers will suddenly realize how limited their movement is due to their shortened lats. Hold your arms overhead for 10 seconds, trying to push them as close as you can to the wall. This will feel very strenuous if your alignment is poor. Do as many reps as you can, but at least three per day as part of your warm-up would be a good base.

[fig. 6] Now, keeping your forearms as close to the wall as possible, bend your elbows to 90 degrees, rotating your upper arms to horizontal. Your forearms will still be pointing vertically. As you draw your arms down to this position, it will be difficult to keep the forearms from rotating outward from the wall if you have weak and poorly aligned shoulders. Do the exercise several times daily while you are waiting for coffee to boil, watching TV, or doing a formal warm-up.

For another great article on elbow rehab, see “Stop Ruining Your Elbows. Now!”

Dave MacLeod has completed V15 boulders, 5.14d sport climbs, E11 traditional climbs, and 5.14a free solos. He has MSc degrees in Sport and Exercise Science and in Human Nutrition and is the author of two widely acclaimed books about training and injury prevention: 9 out of 10 Climbers Make the same Mistakes and Make or Break. He also runs a popular blog.