Thursday, February 08, 2007

Elbow and training

Elbow tendinitis is one of those issues all serious climbers have to deal with sooner or later. I've done battle with it off and on for literally 25 years. I think what always kept me from developing really serious problems was my "off" season, when I would go kayaking or paragliding for at least a couple of months. This allowed some degree of rest, or at least very different motions. I often felt like I was losing all fitness during this period, but usually came back within a month or so to near-peak fitness. In '06 I had a strong mixed season that, due to poor conditions for flying, went straight into a hard rock season. I was climbing rock as hard as I have in 10 years, and training hard for that. I did have some rests of up to four days, but climbed hard consistently at least once a week and normally three to four days a week. At the US Paragliding Nationals I still managed three days of hard climbing in eight days--that was about the biggest "rest" I had.

I was also doing a lot of yoga and hand-stand pushups, both of which put tremendous torque on the lower arm's flexors. In Ashtanga yoga you do a lot of "swing" throughs from standing to sitting with your legs in front of you in an L-sit and then back through your arms to a push-up position. I'm not very flexible, and think the "jerkiness" of this movement for me likely stressed an already stressed common flexor tendon. I also got to the point in my handstand pushups where I was starting to balance through the movement rather than just keep my feet on the wall; this also put a lot of stress on the common flexor tendon in my elbows. I then beat the hell out of my elbow on the Yamnuska multi-pitch project--climbing, hauling, cleaning, it all also adds up. Looking back, I was just hammering on my elbows. They both hurt a little, but I've dealt with that in the past with changing up my climbing style, and then also taking that big "off season" break for flying or paddling. On the Yam route my left elbow started to hurt not only while climbing but while living; picking up frying pans, moving rocks (did some landscaping in there as well), but I pushed through it to get the Yam route done. I don't regret that decision, but sure has cost me this fall and early winter. In retrospect, I wish I had taken a month off after the Yam route, but I tried to keep training at lower intensities. Doing too much on the elbow flexor was the first problem, then not accepting the problem and dealing with it was the second big problem. I'm still paying for that decision...

I've been going into Calgary having James at Adjust Your Health work on my elbow. It's not all flowers getting Active Release massage work done (in fact, some of the movements are among the more engaging sensations I've ever felt), but James can pinpoint issues in my elbow and work on both the immediate problem and also the surrounding structural issues. The relief from these sessions is fairly immediate; next day the elbow hurts, but not in that "tendon" way, more of a, "Damn, what just happened?" way. The tendon pain has been steadily decreasing in "sharpness" and overall severity. The acid test is, believe it or not, washing my face. This morning I washed my face pain-free, which was pretty cool. ART doesn't seem to be the immediate cure, but it's the first thing I've tried where the line of improvement/not is slowly up, so I'm going to keep doing that. I can actually feel the crunchy bits in my tendons releasing as James works on them, bizzare but also cool.

I've resisted the full-on drug route as I am pretty careful about what I put into my body. In my twenties I did a lot of anti-inflam drugs for finger issues, those only really resolved themselves when I stopped taking NSAI drugs. NSAIDs are great for symptoms, but I don't think they help much with the actual causes of the problems in the long term.

I went to the gym last night for the first time in a month and did a solid core session then some very light pulling motions in addition to the normal gentle rehab exercises. By really light I mean five pound weights, which isn't very macho. Today the elbow feels better than it did yesterday, so gentle, gentle, I do NOT want to the improvement line to stop trending upward... I've also modified my yoga session to reduce force on the elbow (no swing throughs to seated, limited downward beeyotch) over the last three months, that seems to be helping, and no hand-stand pushups at all. I've been running, skiing and generally beating around in the mountains a fair amount so I feel aerobically fit, but the upper body isn't what it used to be. It's hard to watch muscle atrophy, but at least I have some hope...

I'll make sure I take at least a month or two off in future seasons, I really believe that's critical for healing both body and mind. Patrick Edlinger used to take a month or two off every season to ski, I think he had that idea right.


Anonymous said...

Will, sucks that this sort of thing crops up in climbers so frequently. If ART stops helping you should try some graston or IMS (needles). Graston is a type of friction massage (using metal instruments) that in my experience works better for tendonopathies than ART. But alase it also hurts like hell yielding immediate results. ART seems to work better for myofascial disorders. Choosing the best combination of treatment is dependant on the mixture of physical signs making up your tendonitis. Options are always good and you just have to go with what works best for you.

Chris Noss

Will Gadd said...

Thanks Chris, information is good. Don't you go training too much!

Machavok said...

Hey there Will, sorry to hear about the continual battle with your injury. I hope that it gets better...or at least settles.

So, i know i've talked with you in the past about doing a slide show...but i think i've finally got our ducks in a row here.

We were thinking about the 23rd of March. Are you around for that? Maybe send me an email if you can to let me know if that would work for you or not.



Anonymous said...

Thanks for the updates Will. I too am dealing with elbow tendinitis that has now migrated into even more bothersome bicep tendinitis. I was always ok with climbing injuries that did not hurt outside of climbing but these injuries both hurt in my regular life just like yours. One day at a time I guess!

It is good to keep hearing these different ideas for treatment. Best of luck in recovery.


Bjørn Hammer said...

Hi Will! I have also had serious elbow problems from hang gliding and weight training. I tried resting (no flying/weight trainig), medication, specific training, and changing my flying position (hanging higher) but it only gave temporary improvement. On its worse my elbows were so painful I could not even lift glass of water to my mouth.
What finally worked for me was treatment by a naprapath.

The interesting thing about the treatment was that the therapist focused a lot on tensions in my shoulders and upper back and treated these more than he manipulated my elbows. Still, I'm not complaining because the after 4 treatments my elbow problems were gone. The only thing I do to make it stay like this is to have a naprapathic treatment every 6 months or so.

See the links for information about naprapathy.

Michal said...

Sorry to hear about your elbow injury. I've been rock climbing for over 10 years and dealing with elbow issues for the last 3. The initial bout (medial left elbow) was brutal and I wasn't able to lift glasses of water, turn doorknobs, etc. What really helped were prolotherapy injections (basically sugar water) into the area of pain. The theory is that the tendons get so little blood flow that an acute burst of inflammation is actually helpful. Anyway, that was helpful with the really bad tendon pain. Recently I've been bothered with elbow pain whenever I start with harder climbing above 5.12 or V6 or so....nothing near what I experienced before but still enough to make me back off. Very frustrating to not be able to push hard....good luck.

Hawkins81 said...

I'm not a climber, but I can definitely relate to elbow pain. I never would have thought I'd be going on two years plus struggling with "golfers' elbow." It's interesting how you talk about hand-stand push-ups bothering it, because that's exactly what triggered mine. I had been working out for a couple of years, doing a lot of pushups, and then one day I felt it come on (the acute pain). It's hard for me to know if my job was the underlying problem, because I was on the keyboard/using the mouse a lot.

I had a lot of relief from Active Release Technique technique, but it seems like whenever I try to get back into doing pushups, it flares up to the point where I need to stop and it just gets aggrevated with every additional pushup. I'm seeing a PT right now, and he is working on my back/shoulders with the idea that maybe they aren't operating properly, so my forearms are "bearing the brunt" when I do pushups. Has anyone else found pushups do this to them? I really think mine is a strength issue, and I'm hoping all the wrist curls and twisting excercises will make a difference.

devlin said...

Wow I just had an revelation. I had developed elbow tendonitis recently and couldn't figure out what I had changed to bring it on. I wasn't climbing as hard as I was a few months back and really couldn't pin point it. I thought it was maybe the position on the motorbike. Then Wills comments about hand stand push-ups (which is hard core by the way) and Hawkins comment about push-ups made me think. Recently I had been lifting my two little boys over my head when we were wrestling and it would be a similar movement to both of those scenarios. Hopefully if I stop doing that and the other rehab I had been doing it will eventually diminish. Good luck with eveybody's injuries.