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Screwed Elbow - advice or similar experiences 4-Apr-2006 At 8:36:01 AM chris

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Though I'm not a sports physician, I am a doctor with an interest in various sports-related medical problems. I've been trying to get a bit of information about this problem over the past few years fromo various areas (colleagues, conferences, medical journals, patients, etc). Hopefully my current understanding of this area is a bit helpful....
There's actually fairly extensive research and evolving ideas on management of all forms of overuse tendinosis in athletes.
Most sports health professionals of all types do not recommend long term rest from activity, as the problem just recurrs as soon as you go back to climbing.
Short term rest from the aggravating activity is important, but only in the initial phase to settle any swelling and inflammation, if there is any.
From what I understand, this injury is very much related to actual time spent doing the activity. In one study I have read, the most important factor for achilles tendinosis in runners was the actual time spent running (ie more minutes training per week meant more tendinosis).
It's application to climbing training....
Doing 3 sets of 20 pullups every second day might cause tendonitis, but doing 3 sets of 2-4 (weighted) pullups is probably more efficient, and much more effective at training true power. The aim is to increase the resistance so that you can only do 2-4 pullups, either by doing them on small holds, or with added weight. Rest days are very important, especially after any training at high intensity.
I have found my tendinitis problems have dissappeared since I changed from "high rep/low intensity" to "low rep/high intensity" exercises.
This basic idea of pullup training can be extrapolated to other types of training also. I have found it beneficial to separate "endurance" and "power" training. It is surprising how often your "endurance" training actually includes quite powerful (high intensity) exercise. In general, there needs to be more rest period between power training than endurance training. If your endurance training actually includes a lot of power, and you are doing a pseudo-endurance day after a power day, you will be very prone to tendonitis.

From talks with some physios, it seems that the exercises recommended now for preventing tendonitis are "eccentric" exercises. This means resistance in a lengthening muscle.
For elbow tendonitis, eccentric exercise is the lowering phase of reverse wrist curls. When the elbow is very sore, you start by doing reverse curls, lifting the weight with the other hand, then gently lowering it with the affected hand (unassisted). As the elbow gets better, you can add the "concentric" phase... ie do not assist with the other hand when lifting the weight, initially every second or third rep, increasing to every rep. What weight to use? Start with a weight that does not flare the pain up, and gradually increase over a couple of weeks.

Herbs, magnesium, etc are loved by magazines, etc, but the reality is that nothing will work as well as altering your training and strengthening the appropriate muscles. There is no evidence that any of these "supplements" do anything. If they do, their relative benefit is miniscule compared to changes in training behaviour. There is probably some evidence for anabolic steroids (not corticosteroids), but they are obviously illegal, and even that evidence is controversial. Some of the sports physicians in Sydney are recommending topical glyceryl trinitrate, which are the "patches" used by people with angina. It has been shown to be partly effective in some athletes with achilles tendonosis. You use a quarter of a patch on the affected area. It's expensive and probably doesn't work very much.

All in all, the desire for something that you can "eat" or "rub on" to cure for your tendonitis is much like the desire for obese people for an "anti-fat pill". In reality you just have to do the hard work... change your training, do the right preventative exercises, and don't rest for too long. There have been numerous studies into "rest" as a treatment for various medical problems, and it has been found to be beneficial for almost nothing!! Unfortunately nothing in life is for free... you will not climb V10 by sitting on your ass all day (but you might if you spend all day sitting on your ass, pulling onto your hangboard every 5 minutes!).