Current status:Mid-Feb 2008: Tweaked elbow (golfer's elbow, join of the tendon inside my forearm to the bony spur at my elbow) bouldering indoors. Elbow felt fine afterwards and kept climbing.
Feb - March 2008: Continued climbing but a mild pain started to build up. Eased off climbing in proportion to pain, but pain continued and worsened.
April - May 2008: Realised (far too late) that I was getting properly injured and eased off climbing a lot more. Pain stayed at a constant level.
June - July 2008: Mostly rested for six weeks until mid-July, started therapeutic exercises.
July - Sept 2008: Eased back into climbing at up to 50% of my usual physical limit. Pain still present and initially no better than before rest. Slowly pain seems to alleviated a little but still prominent and variable.
Physio recommendations:Physio 1:- Any climbing usage is likely to re-damage it and slow down or inhibit healing.
- Taking 3 months total rest would likely be a good way to let it heal.
- Intensity of climbing is not so relevant, even gentle use is damaging.
- Recommends icing after any exercise.
- Recommends regular massage with ibuprofen gel.
- Recommends use of an epiclasp restraint below injury site.
- Therapies listed below are all useful although eccentric exercises should be mild.
Physio 2:- Climbing at up to 50% will be fine for my elbow and possibly beneficial in conjunction with other therapies.
- It will take several months to regain a good level of strength.
- Total rest is not necessary providing I am disciplined.
- Ibuprofen is not recommended for long-term healing.
- There may be some issues with my shoulder / back that should be treated.
- Therapies listed below are all useful.
- Recommends taping and being cautious with epiclasp usage.
Physio 3:- Climbing at up to 50% will be fine for my elbow and possibly beneficial in conjunction with other therapies.
- It will take several months to regain a good level of strength.
- Total rest would actually be less recommended due to loss in strength and dangers of building back up from scratch.
- If pain is prominent I should drop the level I'm climbing at rather than stop.
- If iced water feels better than icing, I should stick with ice water.
- Ibuprofen does inhibit the healing process (reduces white blood cells).
- Recommends taping across the injury site.
- Therapies listed below are useful.
Other sources (e.g. Dave Mac's writing etc):
- Iced water recommended.
- Ibuprofen not recommended.
- Therapeutic exercises all recommended.
Current therapeutic practices:1. Ice water bath 2 x 30 minutes daily.
2. Eccentric wrist curls 2 x 3 sets x 10 reps, 5 days per week.
3. Reverse wrist raises 2 x 2 sets x 20 reps, 5 days per week.
4. Press-ups 2 x 20 reps, 5 days per week and/or after climbing.
5. Massage and stretching 2 x 10 minutes daily.
6. Massage before and after climbing.
7. Ice after climbing (or ice water if ice does not alleviate pain).
8. Climb only up to 50% of physical limit and avoid anything further.
(Note that I probably do half as much of the therapeutic practices as is recommended)
In my actual experience:Good (i.e. less pain):
- Iced water
- Massage
- Eccentric exercises then massage
- Taping across elbow
- Random days when I wake up and it feels fine
Indifferent:
- Climbing steadily (more tender to pressure later in climbing session but reduced to normal within a day)
- Epiclasp below injury site
- Taking ibuprofen when climbing (reduces pain but reduces healing)
Bad (i.e. more pain):
- Sleeping on it funny and waking up with random pain
- Any obviously harder pulling
- Strenuous gardening / DIY
- Regular icing i.e. ice pack
Finally...What I've done in the last couple of months is monitor the pain and what I can do on the elbow carefully (those being the only - and vague - indications I have of what is going on), and to seek as much advice as possible from different sources. I take all that advice, mix it all together, see what comes out as the average, and then tally that against my physical instinct and what it actually feels like. That more people have said "keep going" than have said "rest completely", I'm not taking that as gospel nor as a carte blanche to climb lots - I realise that caution and discipline are essential. Based on this I am going to keep climbing at a low level, perhaps reducing the level a bit, but making sure that I rest as much as possible and do the therapeutic practices as much as possible.