Elbow Pain with Climbing: Common Diagnoses and General Recovery

Rock climbers are no strangers to elbow pain… sometimes it strikes after a climb, sometimes it tingles, sometimes it sets in with a combination of symptoms in the shoulder or neck…

There’s a whole host of reasons as to why climbers might experience elbow pain.

And, we’re here to review some of the diagnoses that are most commonly associated with climbers. In this blog, we’ll cover what your particular symptoms may indicate in regards to specific diagnoses — and what general recovery looks like for each.

Let’s begin!

Lateral / Medial Epicondylitis

This one sounds like a mouthful, but you’re probably more familiar with it than you realize: people commonly refer to this diagnosis as tennis or golfer’s elbow. (Not so much “climber’s elbow,” though.)

More specifically, epicondylitis refers to an irritation of the tendons on the sides of your elbow joint. It’s usually brought on by overuse and strenuous activity at the elbow joint

Symptomatic pain doesn’t usually occur as you climb — most commonly, you’ll experience a dull ache after climbing, which eventually subsides.

Unfortunately, because this pain isn’t particularly aggressive, most people tend to ignore the symptoms until it actually starts to affect their ability to climb. And, as you can guess, ignoring symptoms until they worsen isn’t the best way to manage pain.

The recovery timeline for epicondylitis can vary from athlete to athlete, depending on how severe the issue is. But generally speaking, there are a few essential steps for the rehabilitation process:

Begin by loading the tendon. Tendons are made of fibrous tissue that requires deliberate loading in order to become stronger. As with most tendon injuries (excluding tears), lateral epicondylitis necessitates progressive, repetitive overload.

Identify any surrounding deficits. When your elbow tendons are in pain due to overuse, they’re compensating for other tissues or structures that aren’t functioning properly. As you work to regain tendon health at the elbow, make sure you also get a comprehensive evaluation to pinpoint what deficits are causing overuse in the tendons. (A common example includes weakness in the shoulder muscles or poor stability in the scapulae — both of these deficits cause your extensors to work harder as you climb, offloading that compensatory work onto the tendons.)

Transition into progressive strengthening. Once you know what tissues to address, you’ll need a game plan to target those specific movement deficits! This part of your recovery may include a variety of training and exercises that dial into improving muscle activation and strength output.

Address any technique deficiencies. This goes for both the sport-specific exercises in your training program AND the techniques you use while climbing. For instance, some athletes don’t load well enough through their feet while climbing, whereas others rely on one side more than the other.

Seemingly small deficiencies like these can cause muscle imbalances and overuse issues on one side of the body, and correcting them will go a long way in preventing the injury from returning.

Associated Pain with Neck or Shoulder

Alright, we know this doesn’t sound like an official diagnosis…

But, in many cases of elbow pain, the problem doesn’t actually start in the elbow — oftentimes, the pain is a result of other issues in the upper extremity.

Most commonly, climbers will experience pain that refers either from the neck or from the shoulder. And while either can be brought on by a variety of diagnoses, the kind of symptoms you present can tell you a lot about how to manage and alleviate the pain.

Pain Referred from the Neck

Pain that starts in the neck and travels through the elbow joint is often associated with nerve pain or aggravation.

This is referred to as cervical radiculopathy, where the nerve in your cervical spine experiences some degree of compression that can lead to numbness, tingling, weakness, or sharp pain. The symptoms usually strike when you move your neck, and it can travel from the neck, down the arm, and even into the fingertips.

Most treatment plans for cervical radiculopathy will include a handful of specific exercises to target the tissues that surround the nerve.

You’ll likely begin with nerve glides to initially decrease neural tension — this alone should help ease some of your symptoms to feel more manageable. From there, you’ll transition into exercises that target your thoracic mobility (and possibly your cervical mobility, as well). This will ensure that your neck and upper back muscles are pliable enough to move you through your complete range of motion without increasing tightness in the neck.

As your mobility improves, you’ll progress into strengthening exercises for your deep flexor muscles. (Poor activation or weakness in these muscles are prime culprits for radiculopathy.) Improving this muscular strength will ensure that you can move your neck, shoulders, and back without compensatory movements that compress that cervical nerve.

Depending on the severity of your symptoms, you may also need to work on any deficiencies at the scapula (i.e., the shoulder blade bone). Many climbers present either an overactive upper trapezius muscle, or poor activation or strength in the lower trapezius. Either of these issues can cause compensations in the neck and shoulder area, so identifying the particular deficiency and knowing how to target it can make all the difference in alleviating your pain in the long-term.

Pain Referred from the Shoulder

On the other hand (or arm), some people experience pain down their entire lateral shoulder and into the elbow.

The symptoms of this kind of pain are quite similar to those of epicondylitis: you’ll usually feel an achy pain that sets in after a good climb, and usually after more strenuous activity within the shoulder joint.

Typically, this is indicative of rotator cuff tendinopathy — which will ultimately require a treatment plan quite similar to epicondylitis, but targeted to the shoulder.

You’ll begin by loading the tendons in your rotator cuff to ensure proper strengthening, then pinpoint what potential deficits are contributing to the overuse injury. After identifying what tissues require attention, you can work towards a progressive strengthening program to target the necessary muscle activation, strength, and control needed to correct your movements.

For rotator cuff tendinopathy, you’re also likely to incorporate thoracic mobility drills into your program. This will ensure that all the muscular structures around your neck, shoulder, and spine are pliable enough to allow for fluid, complete range of motion.

Get Back to Climbing Pain-Free

With full-body sports like climbing, aches and pains are bound to happen once in a while… but they shouldn’t be left unchecked! Experiencing symptoms in one part of the body hardly ever indicates a problem local to the pain — more often than not, it’s a sign that another area of the body requires attention.

If you’re experiencing elbow pain, pay close attention to where it’s coming from. Even when it’s not particularly painful or aggressive, those symptoms are a signal from your body! Consider speaking with a sport-specific PT who can provide specialized insight into what’s going on and what you need to do to truly fix the issue.

By Dr. James Liaw DPT CSCS SCS

Dr. Liaw specializes in working with athletes of all calibers, spending the early part of his career in a sports medicine residency and creating sport-specific rehabilitation programs. He later went on to serve as the team PT for the Idaho Steelheads (Boise’s minor league hockey team) and furthered his expertise in sports rehab, injury prevention, preparticipation screenings, and return-to-sport testing. During his free time, he enjoys climbing (both in the gym and outdoors), watching sports (49er faithful), mountain biking, snowboarding, learning new things, and eating good food.

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