Elbow: Tendonosis

I started climbing six months ago and gradually increased my level to a lethal week: four straight days of hard bouldering and in the following week three days of trad, before my more experienced friends took away my rock shoes and booked me in with the physio who diagnosed elbow and knee tendonosis.

I started climbing six months ago and gradually increased my level to a lethal week: four straight days of hard bouldering and in the following week three days of trad, before my more experienced friends took away my rock shoes and booked me in with the physio who diagnosed elbow and knee tendonosis. I have since seen professionals, and the common denominator seems to be my hypermobility. I’m sticking to my stretching and gradual strengthening routines (incorporating your advice in Dodgy Elbows, No. 156). At what stage can I go back to the wall? Is it a good idea to build up shoulder strength to support grumpy elbow tendons? Are pushups recommended?

Sophie | Rock And Ice Forum

In a nutshell, you can rest as long as you want, but gain nothing in the long term. If you are relying on that option you might as well take up synchronized swimming.

When I hear that hypermobility has been a major contributor to a certain condition, there are usually two possibilities: a) the patient hasn’t understood or, b) the clinician has no idea.

There are two scenarios: first, your elbows are sore because they are a bit loose, albeit you work them in a fairly moderate range of motion while climbing (i.e. little or no hyperextension), or, second, your elbows are sore because for the last six months you have spent an obscene amount of time hanging on by your fingertips in your Jesus pose. Mmm, that’s a tough one. I’m going to go with chronic overload related to your (s)training program.

One of my patients can, quite literally, sit on the back of her head! I treat several contortionists, none of whom are falling apart due to their extremely strenuous circus acts that often require gob-smacking strength and repetition. Why? They train like professionals.

Hypermobility does not translate to instability, whereby you might expect chronic tendon pathologies. In your case, however, a lack of tendon strength, not hypermobility, is the single factor that has you traipsing down the merry path of self-destruction. If hypermobility has any role at all, it will be minimal.

Just like there is a leisure class at each end of the social spectrum, there are more injured people at each end of the flexibility spectrum. Certainly, more flexible people have to be careful about loading a joint at its end range, where strength and control diminish significantly, and the likelihood of an acute injury is amplified. Training these two important variables will mitigate the risk greatly.

Your primary malfunction is not hypermobility, however, but rather a combination of that beautiful, ephemeral, wide-eyed excitement you see in some people who climb — and a body that is not conditioned. Rein in your mustang of enthusiasm and let those poor tendons recover a little.

An eccentric rehab program [like that described in Dodgy Elbows], in conjunction with modified training, bad-habit expunction, and a little manual therapy is consistently effective for tendonosis. If they are not working then either the program needs tweaking or the diagnosis is likely to be incorrect, in which case an MRI would help clear things up (I mention this more in relation to your knee issues).

Shoulder strength, excellent idea. Pushups — average exercise. Hyper-mobility — irrelevant.

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