Rock Climbing Elbow Injuries with Wil Seto

Mark: Hi, it's Mark from TLR. I'm here with Wil Seto of Insync Physio and Sports Physiotherapists in Vancouver and North Burnaby. And we're going to talk about rock climbing injuries, specifically elbow injuries. What's the cause of this Wil? 

Wil: Yeah. So first of all, like rock climbing injuries with respect to elbow injuries, it's the second most common type of injuries that you see in rock climbing.

And usually it's an overuse chronic type of injury. So there are some sort of more acute sort of traumatic type of injuries, you know, where you get from like a fall or something like that. Those are far and few versus the chronic type of overuse ones. They can sometimes mimic what people also call it golfer's elbow or tennis elbow.

The other one is I guess it's related to the shoulder, but it can also happen down closer to the elbow, is biceps. So depending on where the injury starts to happen or where you start to get problems and symptoms or whatnot, then you can start to get a biceps overuse injury. And it's the very common thing to happen. 

Mark: So what are the symptoms of an elbow injury from rock climbing? 

Wil: Yeah, it can start off as the soreness that you get from a workout and you think that it's just, oh yeah, I had a hard workout. You know, when you push it in the gym and you feel sort of that delayed onset muscle soreness. And then it continues and it doesn't go away. It can be really sort of a low lying nagging thing too.

And that's the thing that tricks most people. So it starts off as just this little lowing, like ache that's totally tolerable, and you end up like, trying to climb through it and it just doesn't go away. And then like, you know, a few days turns into a week and a week turns into like two weeks and several weeks.

And then quite often I'll see some climbers in here that ended up like, Yeah, it happened like four or five months this has been going on for. And either it's not getting any better or it's getting worse. And so there's a few factors involved with that as well, in terms of, you know, like what contributes to these types of injuries.

And usually one of the biggest ones is just over-training. Over-training, overloading it and not enough rest and recovery. So I'm actually treating a young rock climber right now actually. He's only been climbing for three years, just coming on three years now this summer. And he's basically five days a week in the gym.

That's a lot of training and he's basically all high intensity. Every time he goes out, he givers. And so as a result, he's not really resting. And as a result, he's having such a big overload in his elbow and his forearms that that's why he's getting problems. And actually it's been leading to some hand injuries too. So it kind of trickles down. 

So the other interesting thing about someone like this too, is he's a student. He's first year engineering student and he's on the computer a lot. So now you're compounding all that climb training and all the things that you do on, you know, like already overloading in terms of a physical activity perspective.

And now you look at, okay, you know, so let's say he has a job or another person that has a job that's on the computer. Same thing. Now you've got all got all this repetitive strain happening in the forearm. So that's definitely a huge factor.

Mark: So is just getting the client history, is that your main form of diagnosis of this injury?

Wil: Well, that's a big one, initially for sure. I mean, it automatically points me to direction of what I'm thinking of and looking for. But obviously in the exam I need to rule out other things. I need to rule out like is there any trauma? And what else is going on? Like, you know, if there's other structures involved, like, so if there is like stuff in the hand, for example, is it like a pulley or a tendon or is it a ligament or is it a tendon in the elbow? So it really helps us like kind of focus in on our objective exam, when we take a really thorough history. 

Mark: And once you've diagnosed, what structure in the elbow or leading to the elbow is the problem? What kind of treatments are you, options do you have? 

Wil: Yeah, so usually like with golfer's elbow, it's similar to like on the inside of the elbow where you can get a lot of overused stuff happening around where the points of where that muscle attaches just above the elbow there. And on the outside, which is the tennis elbow. And it can be the exact same area on the upper part of the elbow. And so basically the first important thing decrease the load. Like take the intensity down, take down like the aggravating factors.

You know, if work, in school, you cannot, then obviously you're looking at the loads of like, okay, well, let's look at your training. Your training five days. Let's get you in the gym and what are you doing? You're doing hard every day. Okay. Let's get you in the gym three days a week.

And instead of doing three hard days, let's just do like for the first week, let's just do easy stuff. And then we're only going to do a couple of days that are a lot more moderate and then an easy day. And build it back up. Because ultimately what we want to do if there's any kind of acute chronic type of swelling, where there's sort of like, it's kind of a low lying, but then you climb and you do something and it flares up a little bit, then that's what I mean when I say acute chronic.

That you sort of have this like continual thing happening and it's there, but then now you're aggregate it even more. So you got to settle down that acute stuff. So when it's swollen, you got to sell it down with basically the RICE principle for the first 48, 72 hours. So don't do much, ice, compress, elevate.

So that's important. And then once you got that going, and then you'd move into the, you know, basically trying to get that healing phase. After 72 hours, up to a week is sort of that middle phase of that healing. Where it's laying down, you know, the collagen. Collagen is the basic building blocks of the muscle, tendon and soft tissue.

And then, there's the what's called the final stage, which is called re-modeling, which we want to really work at specific type of exercises. Now that's not possible if you have a lot of other stuff going on where it's not even allowing you to activate that. So this starts to become, oh, well, what caused this?

So we want to really look at, are we addressing the root cause of this first? And so that's how our treatment will be guided because if we can figure out what the root cause of the elbow issue. So maybe there's an issue in the neck. And actually with this individual, he has a neck issue. It doesn't hurt, but he did get in an accident and he had whiplash like when he was younger, but it doesn't give me any problems now, but he's really imbalanced.

It doesn't have any neck complaints per se, other than the fact that it's tight, normal tight. And so that can actually compromise a lot of the, what we call the normal movement patterns of that whole like shoulder, neck, elbow, forearm, our hands and fingers. So then what ends up happening is that that movement pattern is now like totally off.

And so we have to retrain that. And so part of looking at what we needed to retrain that is we've got to also look at what's imbalanced. So things are pulling, you know, and we can get into it a little bit more of that, especially when we look at shoulder. But you get that into the elbow as well. So there's all of these imbalances that happen all the way up. 

Mark: And what sort is the typical treatment timeframe to get that retraining underway so they can get back going five days a week. 

Wil: Yeah. So it depends on how ingrained chronically it is. If it's something that's just started and people come in right away, it will be relatively quicker. And I say this relatively quicker. And so this quotations, like the retraining part will still take a good several weeks, a few months and then ongoing sort of retraining it. And, it's like, if you don't use it, you lose it. And so if it's more ingrained, the dysfunctional movement pattern, then the longer you got to retrain it.

So I'm working with some climbers that have been working for quite a few years now where we've been trying to help them retrain your functional patterns for over a year, year and a half. It gets better, but they climb hard and they forget to do their exercises and the recovery stuff sometimes.

So we had to reset it. And so they come back into the clinic and see us, and then we actually have quite a few rock climbing physiotherapists here that work at the clinics that can help with that too.

Mark: So if you have elbow pain and you're climbing, you need to get it looked after, it's not going to go away by itself, especially if you're climbing hard. Guys to see in Vancouver are Insync Physio, you can book online at insyncphysio.com for both locations. In Vancouver, you can call them and book as well at 604-566-9716 or in North Burnaby, 604-298-4878. Get in there and get some help. Get started on your retraining. Thanks. Will.

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