Case Study #1:
The Climber's Elbow

Let’s throw some real-time situations out there to give you some context for different types of elbow pain – and there are many.

What resonates with you in this first case study? Do you have an emphasis on chin-ups, pull-ups, climbing, kipping, muscle-ups, etc where the heavy pulling motion is used? 

CASE STUDY 1 – John’s MEDIAL AND LATERAL ELBOW PAIN

HIS STORY: (acute Climber’s Elbow)
John’s pain began last week after an evening trip to a climbing gym:

     
The pain on the outside of my elbow is similar to a piercing ache (in what feels like the joint itself) around the mass of my brachio-radialis muscle. The pain also felt rounded onto the inside of elbow at the very bottom of my bicep. 

It subsided after about 36-48 hours but got aggravated again following a night involving extensive arm wrestling and beer with a few friends. This morning I felt it when warming up, however, it hurt actively when I did a few pull-ups, hurting throughout the entire movement. When I did some bicep curls minutes later, it ached around the entire elbow when supporting and curling the weight. 

As my rock climbing experience is limited to only three gym trips over a couple years, I've never injured this elbow before and have become quite concerned- can you help?

Classic climber’s hold: full pronation with ulnar deviation, potentially creating Brachio-radialis overload and Pronator Teres dominance.

REHAB STORY:
The act of climbing involves flexing the elbow repeatedly with a fully pronated forearm: The biceps are mechanically disadvantaged due to the pronated position, leading to Brachioradialis and Pronator Teres muscle overload. Possibly irritated the superior radio-ulnar joint as well, but most pain is likely from the overloaded muscles, and this is confirmed by the other activities that later re-aggravated it: arm wrestling, pull-ups and bicep curls. 

In a pronated position such as climbing, elbow flexion happens mostly from Brachioradialis and Pronator Teres muscles, with the Bicep relatively disengaged. This leads to overload and overstrain of these muscles initially, with accompanying pain.

This should respond well to myo-fascial release, with gentle trigger point release and stretching into elbow extension, supination and wrist and finger extension. For a full injury management protocol for Climbers Elbow see “Treating Climbers Elbow” at www.nicros.com.

CONCLUSION: Weekend warrior at his best: invincible until the day after! The answer is a slower progressive increase in climbing, to give muscles sufficient time for recovery and strength adaptation. Also, during climbing sessions, stretch in between climbs, and repeatedly open the arm out into elbow extension, supination and wrist/finger extension to release tightness and ischaemia from long holds. A strength programme isolating supinator and biceps muscles will also toughen up his arm for future climbing training.

All for now! Hope Christmas and the restive season (hoping it is restful for you..) is shaping up well,

Ulrik




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