Skip to content

I don't play golf *or* tennis: Lateral and/or Medial Epicondylitis, aka climbing-related elbow pain

Sara Lingafelter
Sara Lingafelter
5 min read

Despite the fact that I don’t golf or play tennis, I came down with a pretty solid case of both golfers’ elbow and tennis elbow (lateral epicondylitis and medial epicondylitis, or, elbow tendonitis) caused by rock climbing (let’s just call it what it is:Climbers Elbow). My elbows started to bother me just about eleven months ago, but like most beginner climbers I climbed through it and didn’t listen when the ache of exertion turned into the pain of overuse. I’m a very typical indoor climber – I progressed really fast, so my tendons couldn’t keep up with my muscles and I ended up injured. By the middle of this summer, I was working a 10b project in the gym that I had dialed on toprope but was desperate to finish on lead — I seriously overtrained on that route one night, and then found myself sidelined and seeing a doctor and physical therapist. Being a climber who has hit a nine-month plateau (10c’s are still utterly out of reach even on toprope) sucks — being an injured climber sucks even worse.

I’m about seven weeks into my recovery, and now starting to get to climb more normally with fewer restrictions (and less total rest than most of the conventional wisdom out there). Last night at the gym I was able to do my first few overhanging routes since my injury-imposed rest started, and I also did the hardest toprope route in a long time — Glen, you’re a sick dude, but that new 10a (I say 10b) is super fun.

Conventional wisdom on climber’s elbow is total rest and daily icing for six or more weeks, followed by a rehab program involving stretching and strengthening. For most climbers, the rest period is an excruciating experience in self-denial. For me, the required rest fell during the summer, which is a very short period of time between the other season of the pacific northwest year — the rainy season. I wasn’t willing or able to stop climbing completely, but I was willing and able to change my training to try to manage the injury until I can take a solid rest this winter.

First, I avoided downclimbing on routes (sure-fire elbow pain trigger or aggravator, for me; I can downclimb “anything in” without issue), traditional pushups and pull-ups, and overhanging sport and bouldering routes. These are all pretty self-explanatory – they’re repetitive, high tendon-stress activities. I also avoided the more extreme traditional treatments – specifically, cortisone shots, since I’ve had a bad time with them with past injuries.

Second, I focused on proper warm-up, cool down and stretching, and generally on rehabilitation and climbing activities that didn’t cause or increase pain. I also tried to focus on less repetitive motions (e.g. exercises involving a balance ball to randomize the activity a bit, and other really random exercises like ball-throwing to make the exercises less strictly repetitive). I massaged and iced nightly and tried to limit my climbing to twice a week, and just generally took things very easy. I braced with the ugliest brace on the face of the planet when climbing, and with a basic neoprene sleeve when not climbing to keep the joint warm. Bracing does seem to help prevent both aggravating and reinjuring the elbow – my worse elbow, which is always braced when I climb and often braced to keep warm when not climbing is now doing better than my “good” elbow. I’m on Aleve twice a day as a result of some other joint issues, but I don’t know how much it actually helps the elbows. I also did a three week course of non-climbing-specific physical therapy, and then developed my own climbing-specific strategies for recovery and injury prevention.

Physical therapy has been incredibly helpful, I think — first, she didn’t insist that I stop climbing completely; and second, she’s focused on building my weak areas (specifically, prior to PT I did not have triceps, apparently) so that even though I’m climbing way below max, I feel quite a bit stronger in areas like lockoff strength and in my shoulders. I’m also pretty sure that the routine she has me doing (emphasizing back, core, shoulders, and triceps) is helping me avoid other climbing-related injuries, specifically in the shoulders.

More specific to climbing, I’ve added in a few exercises from the Eric J. Horst book Training for Climbing (specifically, pronators with a hammer, extensor stretches and wrist curls) and the hanging weight roll-up (and down) described here which seems to have helped both with strength training and as a warm-up exercise before climbing. At this point, I’m still climbing in the ugliest brace on the face of the planet (seriously, can they not at least make it in colors?), but I’m able to do my exercises without bracing, which is pretty cool. I’m still not back to doing full pushups — I’m doing modified pushups with fingers pointed in to work the triceps — but seriously, I’m (just about) 30 years old and was a couch potato until a year ago, so I think there’s nothing wrong with doing modified pushups and generally dialing down the intensity of my workouts.

Belaying off my harness with an ATC turned out to be much easier on the elbows than belaying off the anchored belay setups with a Gri Gri that we have at the gym; also, we have fewer slab and vertical options inside than outside, so I focused on climbing within my ability outside during the weekend, and then climbing easy inside, mostly focusing on drills. Inside, I focused less on climbing routes and more on climbing drills so that if something hurts I don’t have to force it in order to “stay on route.” I’ve done a lot of drilling on slab and vertical walls, and two of my favorite that kept things interesting are:

  1. Foot matching: Work your way up a wall with lots of easy, secure holds, matching feet on every hold, with one foot doing all the upward movement. For example, the first time up, step up with your right; match with your left; then step up with your right, and match with your left. Repeat to the halfway point and switch feet — or, do the whole wall then repeat with the other foot.
  2. Hands low: Keep your hands at or below your shoulders, chest, or waist (from easiest to hardest) and work your way up the wall relying more on your footwork and less on your grip. Elbow tendonitis can be caused or aggravated by overgripping, so using open hand grips, pushing up off of holds, using underclings and side clings, and cracks instead of just pulling your way up jug ladders can help you keep climbing without aggravating overuse injuries. Variations include no-hands climbing, or climbing holding tape balls, so that you’re using your balance and footwork, and not your grip.

Finally, instead of climbing days back to back, I rest at least two days between climbing days to give everything time to recover.

Overall, I feel much improved. I still have a little bit of discomfort (the good ache, I think, not the bad pain) after a hard day’s climbing, but normal activities (work, brushing my hair, getting dressed, lifting a gallon of milk out of the fridge) are totally back to normal. I do think I’ll take a good solid rest this winter and will continue my rehab exercises – I think the routine has a side benefit of helping my whole body (and my climbing performance) so there’s incentive to keep it up.

Enough about this. I just thought I’d put it to bed, since just about every stranger in the gym asks me what the heck is wrong with me when they see the ugliest brace on the face o
f the planet
. I so envy the folks who can climb at high intensity without incurring repetitive stress injuries without taking any special efforts or precautions… but I’m determined to be someone who can climb at high intensity and if it takes special efforts and precautions, I’ll take them!

Sara Lingafelter

Sara (Grace) Lingafelter takes steps forward and backward toward a right-sized life on a daily basis.