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Injuries and Medical Advice

Elbow: Medial Epicondylosis and Taping

I've had elbow tendonosis for the last year and am finally back to climbing pain free. A physical therapist has told me that weakness in my wrists may be placing greater loads on the elbow tendon, and that taping the wrists before climbing might help. Any thoughts?

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I’ve had elbow tendonosis for the last year and am finally back to climbing pain free. A physical therapist has told me that weakness in my wrists may be placing greater loads on the elbow tendon, and that taping the wrists before climbing might help. Any thoughts?

RAY GIROUX, CAMBRIDGE, MASSACHUSETTS

Hmm, not too sure where your therapist is heading with this one. Virtually all the muscles controlling the wrist arise from either side of your elbow, the flexors from the common flexor tendon on the medial side, and extensors from its alter ego on the lateral aspect. Assuming you have medial epicondylosis (see Medicine, No. 156), the muscle usually afflicted is a wrist flexor sporting the handle flexor carpi ulnaris (FCU). Your therapist’s explanation, if not his/her understanding of tendonosis, leaves a lot to be desired. In this malady, the muscle is actually too strong and as a result, is damaging the common tendon at the origin of FCU. It is the tendon at the elbow that is too weak, not the muscle, or the tendon at the wrist as it inserts into one of the carpal bones.

It is possible your PT is referring to laxity (flexibility) in your wrist, and translating this to read instability. The two, however, are by no means linked. Instability is dependent on weakness or loss of motor control, whereas laxity simply means you missed a career performing a triple overhead backbend, your gonads adorning your forehead, while at the same time juggling Oompa Loompahs. At this end of the flexibility spectrum you have a higher propensity for injury (see Ask Dr. J, No. 169), but I would recommend proprioceptive/strength-based exercises rather than prophylactic taping. If ulna carpal instability were the case, you would almost certainly have suffered recurrent pain on the little-finger side of your wrist long before a chronic-overload injury at your elbow.

Taping for prevention is at best futile, and at worst detrimental. Many PT’s love tape. More than a few missed their calling in the bondage industry.

Taping to protect an existing injury, by restricting its range of motion, can be very helpful, though that, too, can cause problems.
The wrist, of all articulations, is one of the more likely to suffer from pointless restrictive taping. The narrowest part of your wrist contains 23 tendons, half a dozen major blood vessels, three major nerves and several minor ones, eight bones and a whole bunch of other stuff that is highly dependent on what little space there is. Do you really think compressing all of this will enhance performance? At the very least you will get pumped faster

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