Severe and Persistent Tricep Pain, Doctors Useless. Need Help

Some information:

I'm in my late 20's and have been climbing for about a year. I am in generally good shape and health. Prior to climbing I took approximately two years off where all I did was play golf 4 -5 days a week and never encountered any pain.

I have had chronic pain for about 6 years now in both my triceps. In college I was heavily into weight lifting which I believe is what caused this injury to begin with. It now hurts if I climb consecutive days regardless of how long and hard each climbing session is.

The pain occurs at the distal end of my tricep right where the tricep meets the elbow and is in the midline of my tricep.

Here are some actions I have taken to try alleviating the pain with minimal success.

I would RICE my injury diligently after a climbing session. However, ice seemed to aggravate my injury more causing severe pain while icing.

I would take Ibuprofen before and after a climbing session.

I tried wearing a compression sleeve and brace for my elbow during climbing sessions.

I also went about some physical therapy exercises to help strengthen my triceps and upper forearms. Did this for a few months and it didn’t seem to help.

After meeting with an Orthopedist he recommended me trying a PRP (Platelet Rich Plasma) injection which I did. I am still unsure what sort of results I have received from the procedure. It is recommended that the procedure be done 2 -3 times and I only have done it once.

Most recently I took a cortisone shot before flying down to HP40. My first day climbing I had minimal pain/discomfort after bouldering for 6 hours. The next day, by my second attempt on my first climb I was in so much pain that I had to run back to the campsite and jump in a hot shower in hopes that it would help. It helped a little but I was still in severe pain.

At this point I am just looking for some relief, if any has some suggestions on some a way I can get some therapies or has a suggestion on someone to see in the DC/MD/VA area that would be much appreciated.

One of the things that worked for me, when I had elbow tendonitis - including my tricep, was eccentric contractions. I did those on a dip bench. Jump up into an arm straight position (don't push up, the point is to only exercise the muscle eccentrically - stretching, not contracting) and then lower slowly. Also stretching helps though that's a little hard with the triceps. My tricep tendonitis was more ventral than central.

Bill,

Thanks for the response.

During my physical therapy stage, I actually did both Dip and skull crusher eccentric exercises. Did not seem to help me any.

I am also fairly certain I do not have tendinitis. After talking to a few doctors and taking 2 years off from exercising tendinitis should have disappeared.

not to state the obvious, but didn't anyone have you get an mri?

Doing some exercises does not constitute doing "physical therapy".

No doctor mentioned or recommended me getting an MRI or an ultra sound.

My good friend is a physical therapist and put me on a program to rehab my elbow. It did not help.

Your doctor is no help so you are going to take medical advice from the Internet from people who haven't examined you? Not smart. I would get a second or third opinion from another doctor. Don't believe anything on the Internet especially medical advice. You could end up in worse shape.

Rolfing Structural Integration may help. There are some great Rolfers in your area. Backchannel me if you want recommendations.

Brian, I have met with 3 different doctors and have taken their advice and has gotten me no where.

First doctor - Take ibuprofen and ice the elbow

Second doctor - PRP injection

Third doctor - cortisone injection

The doctors I have been seeing don't seem to have a good grasp on my condition. If you have a recommendation on a good doctor that would be appreciated.

I had Achilles tendon injury while back. Even with PT, eccentric contractions - low load, high rep, it took ~1 year to get back to semi-normal.

Perhaps you should follow PT regime longer?

I'm not too surprised that doctors were no help. I've seen two doctors for tendonitis and both advised me to "stop exercising that muscle and take ibuprofin," which did me no good (I would leave the muscle idle for months and then it would be as bad as ever the day I finally resume exercise). Finally found a good PT who was able to get rid of the problems with deep massage, eccentric exercises, and stretching. I see where you don't have tendonitis, but my point is that when something is neither life threatening nor completely crippling, doctors tend to have very minimal "go do this" type advice, where often you need somebody who can work together with you for a long period of time to get to a solution.

My advice is to find a good PT and stay with them. It took me over 6 months to get my tendonitis cured. Whatever you have might take just as long, so be patient.

Erez L wrote:...if any has some suggestions on some a way I can get some therapies or has a suggestion on someone to see in the DC/MD/VA area that would be much appreciated.

Find a family physician or physiatrist (physical med/rehab specialist) with the CAQ in sports medicine, and who has access to a good musculoskeletal ultrasound facility. (Most ultrasound facilities do a great job with gallbladders but lack the specialized skills for really good MSK imaging.) In your area I'd look toward either the Fairfax or Georgetown sports medicine programs. They're both teaching fellowship programs, with professors of sports medicine who will have more depth of knowledge. That'll be your best bet to figure out what's really going on. Then be prepared for a long haul, because you're trying to heal tissue that has a very limited blood supply and hence builds new fibers very slowly. Good luck!

Fact is, tendons don't heal in a reliable way to different forms of therapy. If you're expecting a panacea, you're in for disappointment. You can't undo damage that has been done. Scarring and damage to the normal tendon fibers can't be made to disappear.

If your description is accurate, you almost certainly have chronic injuries to your triceps tendon, and most likely partial tears in the tendon fibers. Medicine's not a miracle. PRP, dry needling, rest, eccentric loading exercises, surgical "clean-up" (ie debridement of varying degrees) is used in other tendons. Eccentric weight therapy is the most effective in the knee, but still not that reliable. Your best bet is to find someone you work well with, and systematically go through various therapies reliably. And change your expectations of "getting cured" to managing what is sure to stick with you over the long haul.

Good luck, and best wishes.

-Just Another Useless Internet Poster.

Jonathan Williams wrote:Fact is, tendons don't heal in a reliable way to different forms of therapy. If you're expecting a panacea, you're in for disappointment. You can't undo damage that has been done. Scarring and damage to the normal tendon fibers can't be made to disappear. If your description is accurate, you almost certainly have chronic injuries to your triceps tendon...

Like Al Gore, you speak an inconvenient truth. It really highlights the need for prevention and for early treatment.

For prevention, the key is understanding that muscle builds strength within weeks, but tendons and ligaments work-harden over months to years. Pushing too hard too fast is the express lane to injury. Another is not taking enough rest-and-repair days between climbing sessions, especially the first two years in the sport or when getting back into it after a time away. Mostly these are overuse injuries, and the way to avoid overuse injury is... just what you'd think it is.

For early treatment, as soon as your body is trying to tell you something, listen to it! Playing through pain is a macho tradition in football, but it's a world-class bad idea for a climber. When you start to get a tendinosis or a ligament overuse pain, back off frequency and intensity, and get on rehabilitating it at once. I know it's hard to sell that, especially to the young and enthusiastic, but it's the reality. (Sometimes I think sports medicine is 25% anatomy and physiology, and 75% psychology - trying to get competitive and driven athletes to do less of what they live for.)

You might begin by reading the PDF linked in the 'ruptured elbow surgery' thread. Page 75 or so discusses enthesopathies which is a general term that includes tendonitis. The author mentions prp injections and also dry needling the muscle belly. You might begin with the dry needling since it's much less expensive and even covered by some insurances. You can find PT's who dry needle by going to the IMS or Kinetacore website.

The dies

This won't cure you, but it might assist in pain relief and improve healing: try kinesiotaping your elbow.

www.kttape.com

Thanks all!

I guess its hard to always listen to your body. When I go on a climbing trip for the weekend and my body tells me not to climb 2 days in a row its really really hard to listen. Especially since I am only there for the weekend.

I plan on getting a proper ultra sound and mri done. I also will try the kt tape.

I have read quite a bit about dry needling and the results were varied. I was a little reluctant because I read that some people actually got worse afterwards. Does anyone here have any experience with this procedure?

Hey guys,

So I went to get my MRI and I don't have a follow up with my Ortho for another week.

Below is a link to the MRI shots.

If anyone knows how to read it I'd love to hear what they see.

imgur.com/a/9YcIz#0

Curious what the final diagnosis was.

I wish I got a diagnosis.

The new Ortho I went to see looked at the MRI's and ruled out tendinitis and tendinosis. He said that it is likely that my nerves are the issue.

His first advice was for him to immobilize my arm completely for 2 months and then to do physical therapy.

I told him that isn't really an option so he said that's fine and to just do the physical therapy and take Skelaxin which is a muscle relaxer.

I'm still very frustrated because I do not have a proper diagnosis and the mri didn't help at all : /