Refrain from climbing, sport-specific exercise, and limit anything that causes pain.
Rest: No one wants to hear it, but rest is essential for reducing inflammation and allowing the injured area to heal. Continue to bend your arm to perform basic movements, but avoid activity that causes pain or aggravates the area.
Ice: At early onset of pain or swelling, icing periodically may help. However, after the initial period avoid icing if possible because some inflammation is natural and is a necessary part of the healing process. Over-icing may actually inhibit repair. For the same reason, try to avoid taking NSAIDs like Ibuprofen unless otherwise directed by your doctor. Some research indicates that NSAIDs may even weaken tendons and delay recovery.
Begin stretching, perform massage, and self-administering Active Release Techniques
Stretching: Once the pain has subsided and you are comfortable to stretch, there are several basic mobility exercises that you should perform 2-3 times daily. The following finger, hand, and forearm stretches have been proven to be extremely effective as treatment for elbow tendonitis.
Forearm pronation- Empty-handed, simply extend the injured arm in front of you in a palm-up (supinated) position and turn it inward so that the palm is facing downward (pronated) or even slightly outward.
Flexor stretch- Extend the injured arm straight out, in front of your body, with the hand in a palm-up (supinated) position. With the other hand, pull each individual finger back, one at a time. Then pull all of the fingers back (so that they’re pointing toward the ground). You can also try interlacing the fingers of both hands, then extending the arms and facing the hands palms out.
Extensor stretch- This is basically the opposite of the flexor stretch. Extend the injured arm straight out, in front of your body, but this time with the hand in a palm-down (pronated) position. With the other hand, grab just above the wrist and gently pull down so that the hand of the injured arm is facing the body.
Massage: Sports massage is an easy way to break up the soft tissue in the arm and increase blood flow.
For medial epicondylitis (pain is inside the elbow)- Extend the injured arm palm up. With the other hand, use your thumb to massage the epicondyle area in a circular motion. Begin at the elbow joint and continue to massage down the forearm muscle toward the wrist.
For lateral epicondylitis (pain is on the outside of the elbow)- Extend the injured arm palm down. Massage using the opposite hand’s thumb, starting on the outside of the elbow about two inches above the joint. Work your way down, massaging in a circular motion, towards the wrist.
ART: Different from basic massage, self-administered (ART) Active Release Techniques are used to loosen the muscles in the forearm that have been tightened due to trauma and contribute to inflammation. In addition to stretching the muscles, ART breaks up scar tissue that adds to muscle constriction.
Begin weighted eccentric training
- Wrist Curls & Reverse Wrist Curls: [Perform weighted eccentric training only after you’ve reached the point where you can stretch and massage the injured arm without pain] The wrist curl is the single most useful exercise for epicondylitis from rock climbing. Starting with an extremely light weight, perform wrist curls every other day using a dumbbell or a barbell. While seated, place your forearm across your thigh (or a bench) while holding the dumbbell in palm up (supinated) position. Slowly, roll the weight down to your fingertips and then curl it back up. For reverse wrist curls, place the forearm across the thigh (or bench) in a pronated position. Use the opposite hand to help lift the weight. Focus on the eccentric movement by slowly lowering the weight using only the injured arm.
- Weighted Forearm Pronation: This is exactly like the forearm pronation stretch mentioned above, except now you’re holding an object with weight loaded at one end (a hammer, tennis racket, mallet). Begin with arm extended and palm up (supinated), while holding the far end of the handle, and execute pronation by turning inward. Go as far as you can without causing pain, then return to a supinated position. Aim for 20-30 reps and perform three times a week.
After following the Climber’s Elbow Protocol to the point of rehabilitation, you may want to implement some sport-specific training to help you ease back into climbing. This could involve assisted pull-ups, mobility drills, and even yoga. It’s important that you remember to equalize your training of pushing and pulling exercises, as muscle imbalances are often one of the causes of epicondylitis in the first place.