Golfer's Elbow From Climbing - Solutions, Causes and Assessment

hello everyone we are back with another youtube episode and i have a slightly different person sat next to me today it's not a maddie an ollie or an ella it's james and uh for all of you watching this is james who comes from the sheffield climbing clinic and he is a physio and we're going to do a couple of videos which are going to have very much more of a physio rehab injury direction and we're going gonna have james on to do this with us um it's gonna be myself or another person kind of going through some of these key concepts with james and really sharing our joint expertise and knowledge with all of you out there so that you can advance you know improve your rehab uh try and stay away from injury or recover from injury in a better manner [Music] james is someone who's worked with lattice for some time now um we share some clients um and we've done some work together he's based in sheffield at the sheffield climbing clinic and he's been a physio for about 11 years or so i think yeah he's a climbing specialist so he specializes in working with climbers and also diagnostic ultrasound importantly he is also a keen climber like all of us here which kind of helps understand the situation a lot better doesn't it helps understand climbers yeah yeah um so for today what we're going to address is going to be a topic which is i was going to say near and dear to many of you but i'm not sure if it's dear to any of you is golfer's elbow and this is something which we see as being a reasonably prevalent um issue with climbers in the climbing community whatever the specialization and so i think this will help a lot of people as we go through and really dial down what is golfer's elbow and how do we assess it and know that it you know it is a thing um and how what sort of methods do we use for treating it so first up let's talk about uh golfer's elbow and um you know what is it like how do we know whether how would i know whether i had golfer's elbow um so the the easiest way to describe it is it's usually uh presented as pain on the inside of the elbow um so the the the generalized term for it is golfer's elbow it can also be found as climber's elbow that is another term that it's known as i guess the um the the traditional medical term for it would be medial epicondylitis although we don't tend to use that term anymore because epicondylitis refers that might be inflammation within the tendon and we don't think that's actually the case so it would be a um i for example call it medial elbow tendinopathy um and and basically most climbers would find a pain on the inside of their elbow and are we talking about a pain that's um sort of on the forearm side of the elbow or on the bicep side of the elbow um it would kind of be a little bit in between really it it actually uh the tendon that is affected comes and attaches onto the bottom of the the the upper arm and the humerus but most of the time people kind of feel it right on this sort of bony prominence on the inside of their elbow you can get some pain coming into the actual forearm itself and people do complain of that but it's not certainly isn't common to get pain up into the bicep itself okay so it can it can present differently in different climbers yeah absolutely yeah definitely in terms of uh pinpoint pain often people poke around and say that's where it saw that's where it saw um and and that can vary for sure but most of the time it's quite straightforward in terms of um yeah people will feel pain on the inside of their elbow whereas for example uh tennis elbow or or lateral elbow tendinopathy is is completely on the outside of the elbow um sometimes in climbers tricep tendinopathy at the back of the elbow and it does seem it does tend to be quite pinpoint like that you know what i mean they they aren't um wishy-washy people are saying like it's definitely on the inside of mail though as soon as they come in and sit down with me i'm like what's the problem it's you know pain on the inside of my elbow it's and and i will go as far as saying most of the time if they if a climber comes in and they have pain on the inside of the inside of their elbow it tends to be a sort of tendinopathy yeah okay and um also i think one thing that'd be really good to be able to explain to everyone um watching is that uh we often come across these two terms of tendinitis and tendinopathy and unless you're a medical professional or you know you're really into your training and understanding injuries what for the you know the viewer is the difference between tendinitis and tendinopathy does it matter you know what do they need to know about um no it doesn't matter to a certain extent because what matters is about having it assessed understanding uh the diagnosis and understanding what you're going to do about it so for example lots of patients come in and see me and they say oh i think i have elbow tendonitis um and i don't necessarily correct the terminology and even sometimes um when i get letters or send get letters from gps and stuff like that they will still use that term it's just kind of generally used but basically a tendonitis refers uh to the fact that there'll be some inflammation within uh the the tendon and it's probably just a term that's come from before the understanding of tendinopathy um happened really you can sometimes get an acute tendinitis where there's a real acute inflammation but it's not not that common um most of what climbers will be feeling will be what we call a tendinopathy which is um basically when the tendon becomes tendonopathic um which is why they're having the issue but there isn't any inflammation associated with that so um things like icing it and anti-inflammatories and and that sort of stuff um or corticosteroid injections and and these sort of anti-inflammatory techniques um won't necessarily solve the problem they might help in the short term they might help with pain relief all of those things will probably help with pain relief but it's not something that's going to help adapt the tendon to make it come out of the tendonopathic state that makes sense yeah that makes sense yeah so like as a climber myself and also with clients i've worked over the years is that i've suffered golfer's elbow or climber's elbow on a number of different occasions and it hasn't always been for what apparently to me is the same reason you know this little pathway that caused it and likewise for clients i've worked over the years they've had different specializations they haven't all come from you know like i'm not saying that all climbers who have golfer's elbow are boulderers for example there's not a you know really clear pattern to me so what is it for that you think is you know one of the or some of the primary causes for why we see this golfer's elbow all this pain that's you know we see in our elbow um that's a good question it's difficult to be uh generalized about that because definitely there'll be different causations to why it would start but a lot of the time i see a pattern with sudden change in training or load or something like that we use this term that tendons don't like change and that will be either way and what i mean by that is say for example someone is bouldering at a certain level or climbing whatever discipline they're doing and they will just suddenly start a new training program or they might even increase their intensity of training or something like that there will be then an increased demand through certain areas of the body and the inside of the elbow may be one and if that increase in demand isn't able to be tolerated by the tendon then you'll start to get that tendon become tendinopathic and the person will start to get pain and then the other way of that is if someone has a period of rest or deconditioning for whatever reason if they've got a different type of injury or if they go and do something else for a while again that tendon will have a decreased load capacity is what we call it and then say for example they're like okay fine i've now want to get back to my normal training and just go straight back in to their sort of normal level which is what most people do then they might get it so they could think well why has this happened because i've not done anything different but the difference is that they've had a period of time three or four weeks where they've not kept it conditioned and then the tendon drops off because unfortunately as everyone knows and as climbers know whenever you stop doing something if you're at a high intense level or even not your body's always in this state of kind of okay we don't need those muscles or whatever anymore and you get a bit deconditioned but then people are always keen to get back to where they were as quickly as possible so it's so easy to just be like i'll go back into that and the problem with things like tendinopathy is that you won't necessarily feel it straight away so say for example you've had uh two or three weeks doing something else or a month out or whatever it may be or you decide to suddenly really ramp you've got a trip coming up you've got climbing trip and you think right i'm gonna get really strong for this trip um i'm gonna really increase the intensity i see lots of that i see lots of injuries in general someone's going off to fun or something like that and they just think right let's get strong for it and then they come to me like two weeks before like my elbow hurts you know what i mean um but the problem is that you your body won't instantly react to it so it's not as if you're going to say right i'm going to increase my training and then all of a sudden your elbow starts to hurt it might be three or four weeks into that and then you think well hang on a second why has this happened because it's been fine for three or four weeks but the body doesn't just the tender's not instantly going to become tendinopathic it takes a little while to change but then the problem is that once it has got into that state of tendinopathy it can as loads of climbers who are listening to this will know can take a long time sometimes to get back to where it was yeah and that could be the frustrating thing and i think uh you know what james has just said there really reiterates what uh myself and ollie and everyone at lattice in terms of how we communicate with people via you know social media or our training plans is that this element of loading is just so so important and it's something to take massive attention to and be really really careful with understanding that loading so and we're talking about intensity and we're talking about volume both of those will have an impact on that loading and if you think about taking this back to you know injury management but also the occurrence of the injury in the first place or pain onset of pain is it responds so directly to that those changes in loading so that's why we just love this element of loading as coaches sports scientists physios or you know anyone that looks after athletic performance and health it's just a hugely fundamental factor which determines a lot of things isn't it absolutely yeah absolutely yeah so okay so we've looked at you know what golfer's elbow is where we see it on our body um how we identify it um what do you think are some of the or what are some of the common approaches to rehab that you would take with golfer's album what are the some of the methods that we would look at um for addressing golfer's elbow are we talking about eccentrics are we talking about isometrics are we talking about uh stretching you know what do you think of the the tools in the toolbox so the the ones that most climbers will uh see if they kind of get general advice or or look at something online or something like that will be your classic eccentric exercises so most climbers with this will have probably started the classic kind of weight on the edge of your knee or a table lifting it up lowering it down lifting it up lowering it down or they might do one as well that um rotates um a sort of top-heavy weight i mean exactly yeah and we're saying that this is eccentric loading because we're helping it to the top of the contraction so we're contracting and then we're controlling that open and release of the muscle exactly yeah so so with the golfer's elbow basically um there's actually six muscles that come and attach onto the um what called a common flexor tendon on the inside of the elbow and what these exercises are targeting um are the movements that they do so so basically um there's only one muscle that does this movement here it's called the pronator teres it helps to turn the hand like this but the reason you will do an exercise where you rotate is because of that because it's one of the functions of the the muscle groups that come and attach to that tendon and and the other functions of most of them are to help with the wrist bending um one thing that we'll probably talk about in in a little while is the fact that all of these muscles also help to bend the elbow which commonly is not a movement that people would do to rehab golfer's elbow um because they don't consider that as one of the main roles but it does help to bend the elbow as well um but yeah going back to the actual exercises themselves the most common thing that people will do will be an eccentric exercise so you have three movements of of muscles really eccentric concentric and isometric um isometric is one where you're static so if i hold on to a weight and just don't move that's an isometric contraction a concentric contraction is one where the muscle is shortening so if i was to hold the weight here and bring it up like so that would be a concentric and an eccentric is where the muscle is lengthening so if i lower it down now what most people will do is they will start off with um lifting the weight and then lowering it down and that's called an eccentric contraction and the reason for that is basically historically there's there's been some thought that when you lengthen the muscle and therefore lengthen the tendon it might help to line up the fibers of the tendon again and that's a positive thing because we get a lot of questions about this from clients and on social media people going what's better isometric concentric eccentric and i'm guessing you're going to have an opinion on that yeah for sure there's there's none's better yeah it's about progressive loading of the tendon so what you're aiming to do when you exercise the tendon you know why are we bothering doing these exercises what are we actually trying to achieve and the point of doing the exercises is to stimulate an adaptive response within the tendon so if you do some strength training some fingerboarding whatever pull-ups the reason you're doing it is because you're trying to um strengthen the muscle and you do that by overloading the muscle there's a reaction in the brain and whatever and it and it helps to grow the muscle and get it stronger and it's kind of what you're doing with the tendon you're trying to stimulate an adaptive response um going back to the eccentrics that it used to be thought that that might help to realign the the tendon um because it was thought that the actual tendon alignment gets a little bit affected which may be true but we know now from rehabilitation and from uh imaging the tendon and things like that that actually when someone's pain improves sometimes the tendon is still not in alignment so the idea of the eccentric exercises is a little bit probably to be perfectly honest a little bit outdated um and the good news for climbers is it means that they don't necessarily have to worry about always lifting away lowering the weight lifting the weight lowering the weight they can actually concentrate on um progression as long as it's progressive loading as in when i mean progressive it's this whole thing and loading again exactly yeah progressive loading in a simple term you might start off with doing some exercises with five kilograms and then you'll move on to six seven eight nine whatever it's more load through to tendon because the tendon will only adapt to what you put on it or muscles anything like training isn't it you have to um be specific and you have to advance or progress the training um so so really what it's about is progressive loading so for example when i see um patients with this problem i very rarely start with eccentric exercises um not that would be a wrong thing to do and lots of people will be like well it's worked for me and that's fine but as long as they've done an exercise that loads the tendon and it's progressive then it probably will have helped does that make sense um and then you're getting into uh which is the more appropriate type of movement to start with because we tend to find that through range kind of concentric eccentric doing all of the movement maybe is a little bit more irritable or is perceived to be more painful or difficult to do than just doing an isometric exercise um so it seems isometrics are probably kind of overtaking the eccentrics in popularity at the moment yeah the idea of like long duration isometric exercises are quite popular um but yeah we certainly like like using that a lot within the training that we do so yeah exactly but um there's there's not one that is particularly um you know don't do this and do this it's it's about what's appropriate at certain times depending on how painful or or what area of the tendon is being loaded and what position you're in and that sort of stuff okay uh so next question guessing is that at all is it useful um i think i think icing is useful um to help with pain relief yeah so so it is it is useful again icing is a thing that is out of favor at the moment yep so at the minute in the sort of literature and people are saying to me icin's a waste of time basically now the problem with it is the fact that what they are actually meaning when this information comes out about icing is that in the long term if you have an injury and you ice something or you don't eye something um it actually probably won't make that much difference in terms of how quickly you get back to doing what you want to do so when we're looking at the research and the studies exactly the evidence isn't there that it it you know it makes the making faster so people like people therefore like well it's waste time don't bother doing it but what what you have to understand is it's about what icing allows so for example if you have got something that's painful or um an elbow a finger shoulder or whatever it may be if you eye start most likely you will have a reduction in pain or afterwards it will feel a bit better so it might mean that you then think oh it feels a bit better now i'll go and do my exercises or for example it just feels a bit easier you'll sleep a little bit better which will help recovery it's almost like what else it actually helps with in terms of if you i say if you spend two weeks twice a day icing the inside of your elbow and you have an elbow tendinopathy will that help it um improve and recover probably not but is it a waste of time no i don't think so um you know there isn't inflammation most of the time with this problem so you don't need to ice it and if someone said to me should i ice this problem i probably wouldn't say yes yes it's really really useful but if they said i find that icing helps me because it's helps with pain or it just feels better fantastic then that's that's fine yeah yeah no interesting though there um okay another one stretching and you know this one's a little bit personal to me because i've had some success with this yeah yeah what do you think exactly that's that's an interesting one because yeah for some people stretching helps and for some people it's helped quickly stretching isn't really again isn't really in theory supposed to help tendinopathy uh very much but it kind of depends on how you stretch so a classic exercise that people will do um for for the inside of the elbow is this stretch okay i hate that stretch exactly and i really don't recommend that too much and there's a specific reason for that is because tendons um there's a reason why a tendon will be sore so it might be that you load it too much um and it can't cope with that and the other reason it will be so is because of um compressive stress okay so for example if you do a stretch like this where you're um extending the elbow and you are extending the the wrist all of these muscles are kind of being stretched over two points does that make sense it's kind of in touch in here and then you're kind of really cranking that up and if you have a sore elbow um that's kind of compresses the tendon against the bone and if anything just kind of irritates it a little bit the reason that people like it is because it feels like it's doing something you'll know about that people with it might even be with training as well that people are really interested about doing exercises that feel like they've done something they think oh that feels like it gets it you know what i mean that's the one whereas if i give them an exercise that i think is going to help adapt the tendon or do something else they're like doesn't really feel like it's doing much but that's not the important thing it's about doing the right it's like that belief in the program thing leafing the program exactly yeah it doesn't feel like it's doing much or i think climbers are like that a lot because a lot of times climbers um they want to kind of really feel like they get the most of their session or they really kind of want to feel burnt out at the end of it and things like that so when they're rehabbing sometimes it's a bit like that as well they want to really go for it and they want to really feel like it's sort of doing something but the problem with this type of stretch is is it puts a compressive um load onto the tendon um which it doesn't really like it's the same reason why the inside of the elbow uh the the the golfer's elbow doesn't really like pull ups is because when you get to the end of the range of movement of the pull-up it kind of compresses the tendon in there so a lot of climbers will know that one of the things that really aggravates their elbows is pull-ups um but most of the time the reason for that is because of the top part of the the movement more than anything however um if you stretch uh the muscles that are kind of above and below and for example into the chest into the shoulder then that should in theory off-load the the elbow so so so yeah i think one of the stretches that you're talking about that that you've kind of recommended is a stretch away laying onto your stomach yeah we might have to do a whole separate video to actually explain how that whole thing works exactly yeah but the reason why that's probably helpful for people is because the the hand is kind of in a neutral position so you're not actually kind of forcing that tendon into a little bit of compression and when you do that stretch you're stretching the forearm the bicep the anterior shoulder maybe even a little bit of the pec um and yeah i get i guess that that could help to offload the the tendon but the problem with stretching in theory at least is that when you have a tendonopathic tendon stretching it isn't actually going to help change the ability for that tendon to take load and that is the problem with a tendonopathic tendon but like anything and what's important as a coach or a physio or whatever that you don't say this is completely useless because there'll be people watching this and people that we both know who will have done stretching or have done massaging or something like that i'd never been like that sorted out for me do you know what i mean so so um but in theory stretching isn't the go-to thing to start with but it is does have a place but for me the loading and the progressive loading is the way if you if you just stretch most of the time it won't get it better if you do your progressive loading and don't do any stretching a lot of the times it will still improve and if you do both it will still improve but again the difficult thing with it is that there's there's lots of differences with people and that's why it's important to get the right problem diagnosed because it might not be that problem that is the issue um and you're talking about stretching of muscles the other important thing is is maybe things like mobility so for example um shoulder alignment and mobility climbs are classically a little bit hunched in their shoulder and one of the important things uh related around stretching is having good shoulder alignment because basically if you're too far hunched forward in your shoulders and you're pulling you can't engage all of the big powerful muscles like the lats and things like that because you haven't got the alignment there correct so when you're pulling you're kind of going more on the inside of the elbow than the actual um utilizing the big powerful muscles so so that that i think that is more of a thing that maybe uh is useful to to look at rather than just just purely stretching um but i suppose it depends what you mean by stretching because if you said just stretching the forearm muscles no i don't think that's particularly useful because most of it is done like this but stretching um the muscles that connect a little bit higher up uh is probably quite useful yeah yeah well uh i think um for everyone watching you'll have realized that james has you know a huge depth of knowledge here and even just a relatively small issue like golfer's elbow and it's a small part of the body has so many different facets to it and areas that we can look at and obviously like all injuries and the rehab associated with it is highly individualized so you do have to take that individual approach to things but there are some sort of rules and sort of more reliable methods that you can look at with this and you know i think you've heard both of us say this a lot it's that loading thing that you really really want to pay attention to but there are other tools that you'll use with with this to be able to monitor that load and adjust that load um and also make some progression with that rehab um it's been great having james today sat on the sofa with me going through this subject um it's been fascinating for me to be able to talk about it i mean i could probably talk about it all day um and please let us know um if you've enjoyed this type of content it's a little bit different to normal and whether there's any other types of injuries that you're interested in forms of rehab any other questions that you think you know are relevant to the expertise that james brings here so just let us know on that but otherwise we'll sign off for today hope you've enjoyed it we'll see you again very soon and thanks very much james [Music] you

Channel: Lattice Training

Views: 76,438

Rating: 4.8763556 out of 5

Keywords: climbing, training, climbing training, lattice training, rock climbing, sport climbing, Golfer's Elbow From Climbing, golfers elbow, golfers elbow treatment, golfers elbow climbing, golfers elbow climbing treatment, epicondylitis, What is golfers elbow?, What is the difference between tendinitis and tendinopathy, golfers elbow rehab

Id: aUIfegWq31E

Length: 27min 33sec (1653 seconds)

Published: Mon Aug 10 2020

Reddit Comments

[u/d3adly_buzz]

I don't think this a repost. but it surely popped onto my youtube suggestions after watching the video about locust pose that somebody posted the other day. One interesting point from the vid: golfer's elbow is probably not tendinitis, but rather tendinopathy, as inflammation is typically not involved. After many many hours browsing for GE info, it's a real gift to have this sort of deep dive that cuts through outdated info.

[u/hexgrrrl666]

Oh man. Wasn’t expecting a 30 minute video but will definitely check this out later if you found it worth while !