Treating Lateral Elbow Tendinosis

Lateral tendinosis, commonly called tennis elbow or lateral epicondylitis, is an irritation of the tendons that attach the forearm extensor muscles to the lateral epicondyle on the outside of the elbow. The forearm extensor muscles are antagonists to the forearm flexor muscles used so prominently in gripping the rock and, therefore, the extensors are often disproportionately weak compared to the flexors. Furthermore, grip strength is greatest when your hand is in the extended position—this explains why your arm “chicken wings” out from the rock when you struggle to grip small crimp holds. It’s the extensor muscles that facilitate this chicken wing position and, thus, constant straining to stick crimp holds can lead to tendon injury where the extensor muscles attach to the lateral epicondyle. (Note reducing your use of the crimp grip will lower your risk of tendinosis.)

Onset of pain is typically gradual, and will first appear after a hard day of climbing. Without rest and treatment, the condition will progressively worsen to the point that climbing becomes prohibitively painful and even everyday tasks are hampered. Since such a severe case often requires a six-month (or longer) rehabilitation period away from climbing, it’s paramount that you take the necessary steps to mitigate this injury early on.

The treatment protocol for lateral tendinosis is similar to that described above for medial tendinopathy. Time away from climbing is mandatory—very few people successfully climb through elbow tendinosis of either kind. Frequent icing and limited use of anti-inflammatory medication is helpful during the initial period of pain, however these treatments should never be used to allow continuation of climbing. As pain and swelling subside, daily use of the stretching exercises is absolutely necessary as the first step in the rehabilitation process. Gradually introduce reverse wrist curls (below) to strengthen the forearm extensor muscles; add weight incrementally over the course of a few weeks. Use a heating pad for a few minutes before stretching—daily use of a heating pad may also speed rate of healing. In mild cases of tendinosis, you may be able to complete the rehabilitation process and begin a slow return to climbing in six to eight weeks. A counterforce brace worn just below the elbow may be beneficial upon beginning a slow return to climbing.

Remember, recurrence or severe episodes may take six months or longer to overcome—let this knowledge compel you to cease climbing and engage in the rehab protocol described below at the first signs of pain.

Extensors Stretch

In a standing position, bring your arms together in front of your waist. Straighten the arm to be stretched and then make a tight fist; place the fist in the palm of your other hand. With your fist hand in the thumbs-up position, gently pull the fist inward to create a mild stretch along the back of the forearm. Hold this stretch for twenty seconds. Now release the stretch and rotate the fist until it’s in the awkward thumbs-down position. Again, use your free hand to flex the fist and hold for twenty seconds—hold a solid fist and keep your arm straight to best work this strange, yet important stretch (needed to stretch the brachioradialis). Repeat this stretch with your other hand.

Flexors Stretch

In a standing position, bring your arms together in front of your waist. Straighten the arm to be stretched and lay the fingertips into the palm of your other hand. Position the hand of your stretch arm so that the palm is facing down with the thumb pointing inward. Pull back on the fingers of your straight arm until a mild stretch begins in the forearm muscles. Hold this stretch for about twenty seconds. Release the stretch and turn the hand 180 degrees so that your stretch arm is now positioned with the palm facing outward and the thumb pointing out to the side. Using your other hand, pull your fingers back until a stretch begins in the forearm muscles. Hold for ten seconds. Repeat this stretch, in both positions, with your other arm. Finish up with a minute of self-massage to the forearm flexor muscles using deep cross-fibre friction

Reverse Wrist Curls

Sitting on a chair or bench, rest your forearm on the far end of your thigh so that your hand faces palm down and overhangs the knee by several inches. Firmly grip a five to fifteen pound (much harder) dumbbell, and begin with a neutral (straight) wrist position. Curl the dumbbell upward until the hand is fully extended. Hold this top position for one second then lower the dumbbell to the starting position. Avoid lowering the dumbbell below a horizontal hand position. Continue with slow, controlled reverse curls for fifteen to twenty repetitions. Perform two sets with each hand with a two- to three-minute rest between sets. Use a heavier dumbbell if you can easily execute twenty repetitions. Well-conditioned individuals may need as much as a twenty-five- or thirty-pound dumbbell.

Summary Tips for Treating Elbow Tendinosis

1. Cease climbing and sport-specific training.

2. Apply ice to the injured area and take NSAID medications only if the injury produces visible or palpable swelling (most elbow tendinopathy does not). Cease use of ice and NSAIDs as soon as swelling diminishes—further use will slow healing.

3. Never use NSAIDs to mask pain in order to continue climbing while injured. Regular use of NSAIDS (and smoking) may actually weaken tendons!

4. If no swelling is present, begin mild stretching, light massage, and use of a heating pad (ten to fifteen minutes) three times per day. Most important is twice-daily use of the forearm stretches shown above.

5. If no swelling is present and if pain is minor, engage in rehabilitative exercises on an every-other-day basis. Perform some warm-up activities such as arm circles, finger flexions, massage, or use of a heating pad. Use Reverse Wrist Curls for lateral tendinosis and Forearm Pronators for medial tendinosis.

6. Cautiously return to climbing when your elbow is painfree and no sooner then after two to four weeks of strength training exercise. Begin with easy, foot-oriented climbing for the first few weeks and limit use of the crimp grip. Cease climbing if you experience pain while climbing and immediately return to Step 2.

Copyright 2007 Eric J. Hörst. All rights reserved.