Chronic Injury-any ideas

All right, I know that every one is going to tell me to seek 'real' medical advice, but so far I've tried countless methods and nothing brings me relief (plus I'm a poor college student). I'm wondering if anyone has experienced a similar issue.

Most of my intense pain comes in my elbow...the lateral epicondyle (think outside part), particularly on crimpfest type stuff, or while typing on a computer. I also have a very prevelant weakness on my triceps tendon where it enters the elbow when I do pushups or bench press type motions. I think it's all stemming from my back/shoulder where I've got significant weakness in my lat (same side) when I do pull ups or lat pulls. It's pretty diffuse in the upper part of my lat and just feels kind of achy after a good climb or workout session.

I've tried accupuncture, phys therapy, lots of rest, stretching, minor massage, etc. Does anyone have any experience with this type of thing? I'm starting to get desperate as it's been around for over a couple years and really hindering climbing/kayaking/swimming.

Any luck with trigger point therapy or yoga in relation to this type of thing, or any other type of therapy.

If its anything related to tendonitis on the outer part of the elbow, I had it pretty bad for a couple of years after climbing multiple days on steep rock, or bouldering hard. What worked for me was to slowly and consistently do a tricep workout in the gym with weights. Nothing heavy, just lots of different exercises with low weight/high reps. Building up the tricep helps make up for oversized/overworked biceps that most of us men have. Creating a balance in the arm muscles helped to take away strain on the tendons, and I hardly have any pain anymore. In fact I only get it when I forget to do my tri workouts consistently

I have also experienced the same problems. Had to force myself into the gym to workout the opposing muscle groups to avoid imbalance problems from excessive climbing.The gym thing seemed so boring too me but I feel a bit better now with most of the pain subsiding. Also realized pushing 40 Yrs. of age, all those old "ski and snowboard injuries" I received back in the 80's are coming back to haunt me..

Quit drinking coffee, warm up before climbing crimpy routes, & exercize opposing muscles.

coffee huh?

Any regular tingling or numbness in any particular fingers? How many hours a day are you at the keyboard?

Rarely at the keyboard (don't think it's carpal, but...). Very occasionally I get tingling in my fingers, but it's very light and doesn't come very often. Sometimes in the middle finger, other times in the pinky.

SI -

Upper extremity (i.e. arms) issues are quite complex. Not always tendon or muscle related; frequently nerve related -- and that goes beyond 'carpal tunnel syndrome', though it is the most common nerve issue. For instance, i have a mix of tendonitis, cubital tunnel syndrome (ulnar nerve), and other ugly stuff the docs couldn't ever really figure out. So, they lump it into something called 'CTS' or cumulative trauma syndrome (or disorder) -- meaning multiple upper extremity issues. Not saying you have anything like that, but be aware there can be multiple contributions. If it is nerve related (if you do somewhat regularly feel tingling in your fingers, hands) there are a couple of tinnel (sp?) tests you can do to check by tapping in certain locations of the wrist, elbow, etc to see if you get additional tingling in the fingers. Should it be nerve related, just know there are frequently non-surgical things you can do to lessen the source of the issue. Things like bracing your elbows or wrists at night so you don't bend them. Setting up your desk/computer more ergonomically correct. And so on. Anyhow, the only reason I suggest it could be nerve related is because you do indicate some numbness/tingling on occasion, pain in the elbow, and the comment you said about it possibly stemming from the lats or core of the body. I don't think tendonitis will do that, but nerves do travel from the spine to your fingertips, and can become impinged at any point in between. Just some of my unprofessional thoughts. If you want to chat more, drop me an e-mail. I've dealt with lots of my own arm issues in the past two years that have slowed down my activities -- much like you.

Avery

Carefull with the ice, you can end up causing more damage sometimes by over icing. Also don't massage at the tendon attachment, instead work the belly of the muscles. I struggled with some lateral epicondylitis for several years, even with diligant ice and massage. I finally broke the cycle when I started doing light resistance work with my extensors, combined with easy climbing for 3 months. Try to avoid climbing regular when there is no pain and not climbing when there is pain. Your body will lay down spongy scar tissue that will continue to perpetuate a inflamitory response whenever it is stressed.

Sounds like you might have some other issues going on as well, so it might make sense to go see a doc, preferably a climber, to fully assess the extent of your injuries.

I used to have lots of elbow problems. The exercise that cleared it up was doing seated presses on a cable machine.

Also, be aware of how free radicals and antioxidants effect overuse injuries. Free radicals come from overheated oils(chips...use baked ones instead)...(use olive oil instead of other vegetable oils); sidestream smoke; alcohol; pollution; pesticides; viruses; hard and prolonged exercise; radiation. Free radicals are reactive oxygen molecules that oxidize tissue and cause cancer, heart disease, aging, OVERUSE INJURIES.

Avoid free radical sources and add anti-oxidants such as: vitamins and minerals; green tea; yerba mate; red tea; broccoli; tomatoes; watermelon; blue berries; aronia berries (In Old Orchard brand frozen concentrates); vegetables and fruits.

DONT! use ibuprofen, Advil or the others! Too hard on the liver and kidneys. Use bromelain on an empty stomach-no side effects and a very effective anti-inflammatory! If taken with food in your stomach it is not an anti-inflammatory but a digestive enzyme.

Mix this drink: Type I and III collagen-1 scoop; 1 gram vit c powder; 10 oz water; frozen concentrated apple juice to sweeten; 2 capsules bromelain powder; cayenne pepper(sprinkle or two-whatever you can tolerate). Drink only on an empty stomach. If taken with food, the collagen will not be utilized for tendon repair and the bromelain will not be an anti-inflammatory. I have had injuries that hung on for weeks that cleared up FAST with this drink!

Use an Arnica topical gel such as Arni-Flora Gel. Use it like sports creams but doesn't stink. It takes a while to kick in but then often lasts a long time. For minor strains, I sometimes only have to use it once!

Heal Fast!

Kevin Friesen wrote:I used to have lots of elbow problems. The exercise that cleared it up was doing seated presses on a cable machine. Also, be aware of how free radicals and antioxidants effect overuse injuries. Free radicals come from overheated oils(chips...use baked ones instead)...(use olive oil instead of other vegetable oils); sidestream smoke; alcohol; pollution; pesticides; viruses; hard and prolonged exercise; radiation. Free radicals are reactive oxygen molecules that oxidize tissue and cause cancer, heart disease, aging, OVERUSE INJURIES. Avoid free radical sources and add anti-oxidants such as: vitamins and minerals; green tea; yerba mate; red tea; broccoli; tomatoes; watermelon; blue berries; aronia berries (In Old Orchard brand frozen concentrates); vegetables and fruits. DONT! use ibuprofen, Advil or the others! Too hard on the liver and kidneys. Use bromelain on an empty stomach-no side effects and a very effective anti-inflammatory! If taken with food in your stomach it is not an anti-inflammatory but a digestive enzyme. Mix this drink: Type I and III collagen-1 scoop; 1 gram vit c powder; 10 oz water; frozen concentrated apple juice to sweeten; 2 capsules bromelain powder; cayenne pepper(sprinkle or two-whatever you can tolerate). Drink only on an empty stomach. If taken with food, the collagen will not be utilized for tendon repair and the bromelain will not be an anti-inflammatory. I have had injuries that hung on for weeks that cleared up FAST with this drink! Use an Arnica topical gel such as Arni-Flora Gel. Use it like sports creams but doesn't stink. It takes a while to kick in but then often lasts a long time. For minor strains, I sometimes only have to use it once! Heal Fast!

Some good tips here, however some of this information is dubious. Be wary of any information that speaks in absolutes, as few things in this world are that simple.

Bromelain is a potent anti-inflammatory, but it absolutely has side-effects: nausea, vomiting, diarrhea, and decreased blood clotting. The first 3 are seen if you ingest too much for your body to handle. The last one means you probably don't want to take aspirin concurrently, as it is also a "blood thinner." Speaking of anti-inflammatory drugs, there is nothing wrong with taking ibuprofen, so long as you don't over-do it. At normal doses, there is virtually no chance of liver or kidney damage. Those side-effects occur when high doses are taken for days at a time, i.e. you ingest too much. Think alcohol. You get the unwanted effects after having drank too much, right? But drinking just a little is good, no?

As for free radicals, yes they are bad for you. However, bear in mind your body produces them all the time. As for alcohol, it does not cause high levels of free radicals unless you're drinking too much. In that case, you're probably vomiting or at least headed for a serious hang-over. Rather than lay the blame on any one thing, just try to eat a reasonable amount of fruits & veggies and limit processed foods. Matter of fact, limit your intake of everything. Like most things in life, do in moderation. There are few things that the human body can deal with day in and day out that won't eventually cause problems.

I work as an orthopedic physical therapist in private practice. You may well have a lateral epicondylitis but with the symptoms in your upper back and tricep region it is also plausible that you have a more complex nerve entrapment syndrome in the thoracic outlet or a superficial cutaneous nerve entrapment in the arm itself. Difficult to manage without some sort of evaluation or professional help.

FYI: Chronic tendon problems are usually not inflammatory and therefore do not respond well to prolonged use of medication or continual icing programs. The acute tendonitis will respond to anti-inflammatory measures but as it becomes chronic things will progress to a degenerative tendinosis with abnormal collagen tissue with a poor and disorganized bloodsupply.

What about prolotherapy or even PRP?

regenerativesolution.com/

Sounds like you may have tendonosis (chronic tendonitis). There is a PT treatment called ASTYM which is pretty effective if that is indeed what you have. It involves some specific, deep massage using certain tools and a stretching program. Unfortunately, not many PTs have been trained in that area. I'd ask around where you live and see if you can track somebody down who has been trained in it.

I'm getting the ASTYM certification next weekend. Pretty cool stuff with lots of research to back it up.

I find McKinnons advice very interesting and pertinent, especially in light of the suggestion on ASTYM. Repetitive activities put a tremendous amount of stress on the soft tissue structures of the body. Particularly the ligaments, tendons and joint capsules which do not recover and adapt as quickly as the muscle tissue itself.
Self massage is a great tool for dealing w/ chronic pain problems such as lateral epicondylitis which is usually caused by periosteal irritation at the extensor digitorum origin. The extensor tendon and fascia builds up myofascial adhesions during use and if not given enough time to recover and adapt create a less mobile muscle/fascial structure which creates tension on it's tendinous insertions and the resulting periosteal irritation.
From my experience myofascial work is extremely effective and is also popular as evidence by the intent interest the rehabilitation and sports med community has show in the topic in the last several years. I feel that quite a few climbers would be able to effectively treat their own fascial issues through consistent self massage, but most of the time climbers let the little nagging soft tissue injuries slide until you almost need something like Rolfing, Graston Technique ( grastontechnique.com/), ASTYM ( performancedynamics.com/abo…) or Active Release Technique to take care of.
I'd never heard of ASTYM until this evening, pretty interesting that it appears that the ASTYM is being marketed to the PT demographic of the the rehab world and that Graston is focused more on the Chiropractors... I say interesting since it appears that both are "instrument" based myofascial release techniques and both were developed at Ball Memorial hospital. Sorry for the sarcasm I just sometimes wish that sports medicine (and medicine in general) was more than an ego motivated pissing contest determined by who has the best marketing.
btw Jeff, good call on the heads up w/ not using NSAID's for chronic tendon problems. I completely agree.
Good luck w/ the elbow and check into some myofascial release techniques. My irritation aside, the stuff does work very well for chronic/overuse injuries. cheers, BA

Sounds similiar to some ligament problems i was having in my elbows. Its pretty common. All the advice about water, opposing muscle therapy is the right way to go about fixing it.

All I can add is a little tip to deal with the pain while climbing/excercising. If you press firmly down on the point of discomfort for about 30 seconds it will temporarily relieve the pain and let you finish your climb or whatever. I always did this right on my 'funny bone" to take care of the pain when my elbow flared up.

In the end, though, diligent therapy is the answer.