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Proliferative Therapy 14-Sep-2004 At 5:26:44 PM Julian

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Wow, that is some response. You have bridged an enormous amount. You were bouldering in a Sydney summer! This, I will refrain from commenting about, suffice to say- you must be keen.

I can understand your reluctance to see non-climbing medico’s, primarily for the reasons you have suggested. They are obliged to be very conservative in their approach due to not fully understanding the mechanics involved. And in their defence, climbing is a fringe sport and you can’t know everything.

Though it would be better for me to see your elbow, the history is virtually pathognomonic for medial epicondylosis; that is, tendinosis rather than tendinitis. This may sound like pedantics in spelling but the treatment repercussions are large to say the least. The physio you saw has made reference to the latter, but she means the former. I have not read the article she refers to, but literature regarding tendinosis has been around for 4-5 years.

As the name suggests (and the physio noted to you) it is non- inflammatory, though at times of aggravation tendinitis (‘itis’ means inflammation) can coexist with the tendinosis. Ostensibly this inflammation is incidental with regard to treatment. The oral anti inflams will help if there is some acute or chronic inflammation, but I don’t normally recommend them unless you have really pissed it off. Dulling the pain is bandaid therapy and will get you into more trouble.

Additionally, pure rest is a waste of time. Tendinosis is essentially born from a weak tendon insertion, be it from a muscle imbalance causing micro tearing, or a larger acute tear leading to tendinitis and then tendinosis. There are a few different pathways (local) that will get you there; not very important at this juncture.

You will like this one – you can go climbing, in fact I encourage it, with a few stipulations. 100% no crimping. I will say that again - 100% no crimping. 100%nocrimping100%nocrimping100%nocrimping. Get the idea? When you crimp you use flexor muscles that stabilise your wrist. One of these is usually the culprit in medial epicondylosis. Won’t go into too much detail here as I have an article in the next rock mag specifically on this condition.

Second, you need to do eccentric wrist curls (aka, negative contractions) using the muscles on the front (flexor side) of your forearm. For physiological reasons way beyond this reply, this will strengthen the tendon tissue rather than the muscle tissue, thereby reducing the imbalance. If you do concentric exercises (aka isotonic or positive exercises) you may make the situation worse. I will need to call you and explain these exercises re reps, sets, weight etc, so email me your landline numbers. Very high weight eccentric exercises have a better recovery rate than any other protocol I have seen investigated.

Thirdly, ice the area where the pain is. 5 min on and 5 off, three times, once per day. I will tell you more about the timing of this when I call you. For those who are interested, see the next Rock mag.

Lastly, some massage of the area would be good, just to keep things relaxed and blood flowing. I would be curious to know why you got it in the first place. Without actually seeing you, I can’t say what that might be. This is certainly not ideal, but try the exercises and we will see how you go. Keep in mind that, outside of the obvious strength differential, there may be other biomechanical factors involved. Diagnosis and treatment by email/www forum’s is not my preferred method! It can be regarded at best as low quality.

Expect it to take about 3 months to rehabilitate the tendon.

Hope that helps. The take home message here is that recovery is entirely dependent on you. If you are diligent with the exercises etc it will get better.

Oh, and stop doing silly things like climbing with out warming up. Common sense and discipline are your best weapons--end of story.

Talk soon.

Julian