Cover photo by Federico Rimembrana – @fede.ri_91

Preface by Dr. Jared Vagy – The Climbing Doctor

Elbow injuries can start as a mild nagging discomfort and develop into a debilitating pain that makes it difficult to train and climb. They involve a complex differential diagnostic process and can often be challenging to treat. Historically there has been limited research evidence on how best to manage elbow pain. However, there is new evidence now emerging that supports various intervention techniques. Jędrzej has done the hard work for you in this article by reviewing and summarizing the current research on elbow tendinopathy. The article is very comprehensive and goes in-depth into every aspect of the elbow. You will learn the anatomy of the elbow, how to diagnose your elbow pain, and a step-by-step process to treat it. The hope is that you can use this article as a reference to guide you through the rehabilitation process.

Dr. Jared Vagy PT, DPT
Doctor of Physical Therapy
Board Certified Orthopedic Clinical Specialist

Elbow pain for rock climbers - Introduction

Chronic elbow pain is one of the most common injuries among climbers, yet it is also one of the toughest to heal. I should know - I suffered from elbow epicondylosis for over five years! I was lucky to identify the root cause of my elbow issues and solve them, but many climbers are not as fortunate. The generally available climbing resources provide some information on preventing and healing chronic elbow injuries, but the picture is often incomplete, and the advice is rarely helpful. If applied haphazardly, remedies found in books and on climbing fora can often make things even worse and lead to unnecessary aggravation of the condition.

Because of my long-year struggle, since long I have wanted to write a post about elbow epicondylosis. Recently, I got in touch with Dr. Jared Vagy, who is well recognized in the climbing community as The Climbing Doctor. Jared is an accomplished Doctor of Physical Therapy and a University Professor specializing in climbing injuries [1][2]. He also runs a successful climbing site and appeared multiple times on the TrainingBeta podcasts, where among other topics, he thoroughly explained elbow pain causes and treatments [3][4].

I thought it would be an excellent opportunity to team up and write the article together, and Jared very kindly agreed! I hope you will enjoy this post and find it helpful if you are struggling with elbow pain!

Quick Guide to Climber's Elbow healing

Here is a quick step-by-step guide if you are not interested in reading a long article but want to fix your Tennis or Golfer's Elbow pronto.

Phases of the healing process

There are three main phases of the tendon healing process:
  • Inflammation - lasts about 7 days after the injury. Necessary for the initiation of the healing process
  • Formation - takes up to 3 weeks after the injury.
  • Remodeling - starts 3 - 6 weeks after the injury, can take up to 1 year.

The challenge is that if your condition is chronic, it might be impossible to tell at which stage of the healing process you currently are. Moreover, different parts of the tendon could be at different healing phases concurrently. There could be places where constant micro-tearing causes inflammation or areas where the formative or remodeling stage was failed, has stagnated and needs a reset. That vicious cycle of inflammation and degeneration makes recovering difficult and needs to be stopped if you want to get better for good.

Understanding the above healing stages is critical because it will let you apply the correct treatment mode at the right time and help you evaluate your progress. You will be able to tell where you currently are and what to expect in the coming weeks.

Step-by-step elbow healing procedure

If tendinosis indeed lies at the root of your elbow pain, which is often best ascertained by a competent physiotherapist, an effective healing strategy is as follows:
  • Depending on the severity of your condition, either take a week or two or two of complete rest or significantly reduce the training volume and intensity. However, do not take a complete break from climbing for more than a few weeks.
  • Perform forearm massage and gentle stretching to start releasing muscle tension (video massage).
  • Use Myofascial Release to continue loosening muscle tone and scar tissue adhesions (video MET)
  • Apply Deep Transverse Friction techniques (DTF) to break down the degenerated tendon tissue and reinitiate the inflammation phase necessary to trigger tendon healing.
  • Focus on stretching to release the muscle tension further and start realigning the collagen fibers.
  • After about 2 – 3 weeks, begin to slowly introduce rehabilitation exercises to remodel the tendon and strengthen it by triggering hypertrophy.
  • Focus on strengthening the antagonist muscles using appropriate exercises to prevent reoccurrence of the issue.
  • Change climbing habits, crimp less, improve technique, climb more dynamically, avoid locking off all the time.
  • Warm up thoroughly before each training or climbing session. You will find everything you need to know about why you should warm up in this article [5].

Releasing muscle tone and scar tissue adhesions in the forearms

If your condition is not very severe yet, it might be enough to release the tension in your forearms. Take about two weeks off from climbing. During that time, massage and gently stretch your forearms to relieve any passive tension and eliminate scar tissue adhesions in your muscles and tendons. Start by performing massage once