Common Climbing Elbow Injuries and How to Treat Them

Why Won’t This Elbow Pain Just Go Away?

Causes of climbing elbow injuries

When we are climbing there are (typically) just two points of contact between the wall and yourself: your toes and your hands.  Your toes have the luxury (luxury being a relative term depending on how tight your shoes are…) of being wrapped in sticky rubber shoes that promote solid contact between the hold and your foot.  The fingers, on the other hand, have only the skin, muscles and connective tissue in your hand to create that point of contact stability in your upper extremity.  One reason we often see elbow injuries in climbers is because many of those muscles responsible for hand and finger control originate in the elbow.

  • Overtraining: This is probably the “big one” of elbow injuries in climbers.  Your muscles and connective tissue are being subjected to frequent high loads while climbing.  To get stronger, develop resilient tendons and to become a better climber that is not necessarily a problem, it is important to regularly stress the muscles in your arms.  The problem arises when we don’t give our tissues enough time to remodel between sessions.  Climbing back-to-back (or more) days regularly and/or long sessions is not only a suboptimal way to develop strength, it’s also a good way to cause a stubborn injury.
  • Fall On Outstretched Hand: “FOOSH”: Especially with bouldering, landing on the ground is a regular part of the sport.  Not all falls are expected and a common natural reaction is to try and break that fall with your arms.  The forces on your arm when landing from a height can be very high and lead to joint or ligament injury when falling onto your hand.
  • Form:  One of the fun parts about climbing is moving in many different planes and directions.   In the case of strength deficits/imbalances or compromised form/technique, it can lead to excess stresses on tissues not capable of handling them.

Common climbing elbow injuries

So often we will talk to other climbers who will report about their recurring elbow pain that comes and goes but always seems to return and flare up at least once a year.  They often find that they will take some time off, maybe it gets better, maybe not, but it will nonetheless come back even worse once they start climbing and training again. It is not a foregone conclusion that climbing means elbow pain no matter how seemingly intransigent and chronic of an injury it may be.

A few of the common causes of elbow pain that we see in our climbing patient population are:

  • Medial/Lateral Epicondylosis: These are also commonly called “golfer’s elbow” or “tennis elbow”. Often confused or misnamed with epicondylITIS, epicondylOSIS is an injury that results from chronic overloading without giving the tendons that attach in the elbow adequate time to heal and remodel.  The suffix ITIS signifies an inflammatory condition but in the case of most of our climbing patients, it is often an overtraining/inadequate rest condition.
  • Cubital Tunnel Syndrome:  This condition occurs when the ulnar nerve on the inside of the elbow is getting aggravated and is commonly confused with medial epicondylosis as they both present with inside elbow pain.  A common driver for cubital tunnel syndrome is poor form or “chicken winging” where the elbow drifts upwards and causes a pulling force on the ulnar nerve.
  • Collateral Ligament sprain: The collateral ligaments at your elbow keep your arm from bowing in or out. Whether through repeated microtrauma or an event like falling onto your hand that supportive connective tissue can become damaged and lead to instability at the elbow

Exercises for elbow injuries

The source of elbow pain is the biggest driver for coming up with a treatment plan; the treatment for medial epicondylosis is quite different that the treatment for cubital tunnel syndrome though they often present very similarly.  Keep in mind these exercises are given with a specific diagnosis driving the plan of care.  We do not recommend pushing through more than a 2/10 pain with these exercises. Please note that these are not “level 1” exercises so there is certainly room to scale up or down as appropriate.

Heavy Slow Wrist Curls:  If you have researched golfer’s or tennis elbow you have very likely come across eccentrics as the exercise of choice.  Current research shows that it is more about “time under tension” for tendon health; doing heavy, slow concentric exercises are a great alternative that tends to produce less discomfort and you can do fewer repetitions.

Ulnar Nerve Glides: Inner elbow pain, as we touched on earlier, can be driven from compression or irritation of the ulnar nerve as it passes through the elbow.  Nerve glides, also called “flossing” helps the nerve move through its sheath promoting a very gentle stretch and improved range of motion. These should certainly not be done to the point where they set off pain, numbness or tingling.

Scapular Strengthening:  The most common reason one may overload their elbow or fall into poor form is upstream weakness. Y’s and T’s are classics for a reason; when done well they are excellent exercises for strengthening your middle and lower trapezius.  Unfortunately many people will go too heavy in the weight for their Y’s particularly and it is important to scale the exercises to where you are.  We often like to use a band at a wall as an alternative for this exercise.

When to seek physical therapy for elbow injuries

Not all climbing injuries are season-enders.  It can be challenging to know what is going on and if it is important to take relative rest, to strengthen and load the tissue, to focus on mobility, or to seek additional medical care . To ensure a thorough diagnosis, create a recovery plan that is right for you and get back out on the rock as soon as possible please schedule an appointment at our Seattle-based physical therapy office, where we specialize in treating climbing injuries.

About the authors

Jon Sparks, PT, DPT, CSCS is a physical therapist at Union PT in Seattle. He is experienced in treating acute and chronic industrial injuries, postoperative rehabilitation and orthopedic injuries. He enjoys staying up-to-date with evidence-based treatments. Outside the clinic Jon is thoroughly obsessed with rock climbing. When not climbing, he enjoys traveling, exploring new restaurants and snowboarding.

Shannon Russell, PT, DPT is a physical therapist at Union PT in Seattle. She was initially drawn to physical therapy after a series of injuries while competing both nationally and internationally in rock climbing competitions. She also has experience as a route setter in the Seattle area. She has a passion for blending her rock climbing background and love for outdoor activities into her treatment of local athletes and outdoor enthusiasts.