Climber's Elbow

With the recent trend of  cross fitness training in the early 2000's, and the   growing interest in climbing sports, specifically rock climbing,  elbow injuries along with other upper extremity injuries are becoming more prevalent.  


Most often injuries to the elbow are  to the biceps muscle. However a lesser but still common injury to the elbow is a strain of the brachialis muscle which is located close to the biceps and assists  the biceps when bending the elbow. This injury is called Climber's Elbow. It is caused by a forceful flexion contraction of the muscle greater than it is able to tolerate or a forceful over extension of the elbow. Most often this injury, like most muscle injuries, are a result of a previous lesser strain to that muscle that  likely never was caught or was not allowed to heal properly. The athlete then returned to full activity too early resulting in the injury.

Diagnosis of Climber's Elbow begins with a clear understanding of the mechanism of injury. This comes from the patient's report of how the injury occurred.  Using skilled palpation and specific muscle testing of the elbow in various positions, an expert in musculoskeletal injuries will be able to distinguish between the more common biceps strain and Climber's Elbow.

Treatment of Climber's Elbow depends on the severity of the injury. A Grade 3 strain, a complete tear of the muscle away from its attachment point near the bone, is a surgical case. The less severe Grade 1 and 2 strains can be treated conservatively by a musculoskeletal injury expert. Below is a typical progression through the stages of healing for Climber's Elbow.

Acute (Inflammatory) Stage (0-2 weeks)

•  Refrain from using the elbow especially when trying to lifting an object by bending the elbow.
  
• Alternate ice and heat over the painful areas to control swelling and inflammation. I usually recommend 4 cycles of 5 min each (20 min) 4-5x/day.
  
• Massage techniques using trigger point, cross fiber friction, and instrument assisted will help to reduce scar tissue formation and improve proper alignment of new muscle and connective tissue fibers according to the normal lines of movement.
  
• Adjustments, if necessary, to the elbow and surrounding joints such as the hands, shoulder, neck and back will assist in restoring and maintaining optimal joint range of motion.
  
• Taping and bracing can help reduce stress on the healing muscle and limit motions that are painful. However anything that limits movement can delay the healing process so this should not be used for extended periods.
  

Sub-acute (Repair) and Chronic (Remodeling) Stages (2-8 weeks)

• During these stages emphasis is placed on progressively using the elbow to strengthen the muscle.
• Continuing to massage the muscle and surrounding connective tissue along with manipulating the elbow and surrounding joints is still beneficial. 
  
• Start with light isometric contractions (10 to 20% max force) of the elbow in which you are pushing against resistance, like your other hand, without allowing movement. I recommend 8 to 10 seconds holds, 5 to 10 reps, every hour. This should be done at multiple angles of the elbow bent until nearly full pain-free range of motion is achieved.
  
• Once the elbow is able to be moved without resistance applied and  very little pain occurs, you should move towards heavier resistance training such as arm curls. I like using tubing such as a Thera-Band™ because the force is variable as opposed to using free weights in which the weight is constant and much torque is placed on the muscle at the initial phase of the contraction.   You should try various positions of the palm facing up, thumb pointed up, and palm facing down.  I recommend 15-20 reps, 2 sets, 4-5x/day. 
  
• After arm curls, more functional exercises that simulate climbing can be reintroduced such as dips, pull ups, chin ups, and lat pulls.
  

It's important to note that the time frames listed above for the stages of healing for Climber's Elbow are just typical time frames. These would be the expected times only if the healing process occurs normally.  Different body types, conditions, and compliance  will  effect this.

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