As exciting as climbing is, it is both mentally and physically challenging. Weekly training, bouldering, and hang board sessions can advance your grade, but if done without care may lead to injury. Many new climbers (and more advanced) have experienced the dreaded twinge on the inside of their elbow during or after training. If left unchecked, this pain can become increasingly sore, weaken the grip, and make climbing near impossible. This blog outlines the common challenges faced by rock climbers and the step-by-step strategies to address them.

Common challenges faced by climbers

Rock climbers often develop pain on the inner side of the elbow. It is called the golfer's elbow (climbers’ elbow) or medial epicondylitis. It is prominent in climbers due to the high load through forearms necessary for climbing movements.

The muscles that bend the wrist and finger (the flexor muscle tendons: ulnaris), as well as the forearm rotators (the pronator muscle which turns the palm away from the body as needed for climbing), attach to the inner elbow bone (medial epicondyle). While holding on to crimps and slopers, the forces transmit from the fingers to the elbow. To make matters worse, as we fatigue, use a poor technique, or get scared (like clipping during a run out) climbers tend to over grip on holds which sends even more load through those tendons. Yikes!

Another contributing factor is the adaptation of the body. Our muscles get stronger to meet the need for the climb. However, tendon repair and strength take more time to develop than muscles. So, as the muscles get stronger and can pull more, the tendon can strain to keep up leading to that inside elbow pain. 

As the tendon undergoes this increase in load there is a change to collagen fibres. The cells regeneration does not keep up with breakdown over time. As new climbers may climb too much too soon, or more experienced climbers introduce more dynamic movements or volume training, the tendon struggles to keep up.

Step by step strategy to have healthier forearm tendons and stronger hands

1. Once you have sustained an injury to your upper limb, the first step is to reduce the irritable activity.

You want to recognize those early warning signs. The increasing painful twinge after climbing that becomes more frequent is a sure sign to get checked out. Unfortunately, “pushing through the pain” can extend the injury months longer than needed. As much as it is hard to take a break, reducing the time on the wall can relieve the pain and help you manage loading through the tendon. This does not necessarily mean stopping altogether. An assessment by a trained physiotherapist can give you a better understanding of how to warm up before climbing. We will show you how to reduce loading through the injured tendon, and give you tips to keep you climbing.  

 2. The most important step….TO DO YOUR REHAB

Tendons do not get better through rest alone. Taking two weeks off only to return to full force climbing is a recipe for ongoing pain. Tendons respond positively to load. Heavy isometric or eccentric loading facilitates cell adaptation in its metabolism and structural capacity.1 Therefore engaging in rehabilitative exercises to promote cell synthesis and tissue alignment is a sure-fire way to send your next higher climb (V8).

3. Balance

It is important to load the tendon for analgesic and strengthening benefits, but we also want to engage the other muscles of the forearm to create a balance between the muscles (you wouldn’t just use a quad extension machine to get defined legs, would you?) Strengthening the other muscles in your forearm creates balanced strength in your grip and can also improve your grip strength, especially in crimps. This is also a useful way to de-pump after a climb. Engaging the extensor muscles to relax the flexors of the forearm and help relieve some of the tight forearm feelings after a redpoint burn.

4. Look up the chain 

Climbing is a full-body exercise and as technique improves climbers notice their core, legs, and shoulders get as much as a workout as the forearms. Often the cause of the medial elbow pain is poor technique. Over griping on holds, excessively pulling instead of driving through feet, and allow one’s shoulders to “chicken wing out” when climbing can put more strain than necessary through the elbow. Rotator cuff exercises and correct shoulder position during warming up, climbing, and hang boarding (as let us be honest, we all chicken wing out when making a desperate clip) will help strengthen the shoulders capacity so you can climb on pain-free.

5. Nerve glides

The constant feelings of “tightness” common with flexor pain can be from excessive force through the flexors of the hand but also from neural tension. The median, radial, and ulnar nerves run from the neck into our fingers passing around different structures in the arm. When these nerves tighten up, they can often be the source of tension felt down into the elbow. Although stretching the forearms may feel nice but we want to help the nerve mobilize through the tissue in a process called neural tensioners. An assessment by a physiotherapist can help identify which nerve may be irritated and help you incorporate nerve glides into your rehab program.

6. Lastly warm-up

It is always exciting to get to the gym or crag and want to immediately jump on hard projects (guilty!), but it is important after injury to warm up before training. Taking the time to do your rehab exercise, starting on easy climbs, and focusing on technique will help reduce pain levels, stay strong and send your next climb. Working with a trained physiotherapist can help guide when to drop back and when to progress.

References:

N. Maffulli, U. G. Longo, How do eccentric exercises work in tendinopathy?, Rheumatology, Volume 47