Rehabbing Elbows and Pulleys Simultaneously

I’d like some input and partake in others’ thoughts on rehabbing golfer’s/climber’s elbow while simultaneously rehabbing ring finger pulley injuries.

Before this year I’ve previously injured my ring finger pulleys, once per hand, and this year I injured the ring finger of my right hand again during a warm-up. This time quite severely, recovery was long and arduous.

I’ve only recently begun to be able to hang on it, and in doing so I discovered I was about as competent hanging off of my front two fingers as all three.

My pinkies are quite short, so rather than an open-handed four-finger drag I opt for hanging off of three fingers. Including the pinkie makes it so that the middle finger is definitely in a half-crimp and the index and ring finger are nearing those angles moreso than being reminiscent of an entirely open-handed grip.

I’ve been doing the rehab routine from Climb Injury-Free by Dr. Jared Vagy and am completing my third week of long duration hangs this weekend.

Simultaneously, I have elbow problems. This has come and gone, I’ve even been asymptomatic at one point (thanks Theraband Flexbar) but I’m not asymptomatic at the moment. I have symptoms in both elbows, but my left is worst by far. I was raised to more or less ignore pain, and in doing so have managed to develop quite severe tendonitis.

While I’ve had success with daily use of the Flexbar in the past but found that using it causes a lot of torque being applied to my fingers. I find that routine use eventually results in fingers popping, and I do not want to injure my fingers yet again.

Recently, I’ve been doing

  • wrist curls with an attenuated eccentric (not eccentrics alone)
  • DB supination/pronation
  • finger rolls with wrists fully extended (bottom of a wrist curl)

at 3x/wk frequency at 3 sets of 30-50 reps which I’ve undertaken after reading the following Overcoming Tendonitis - Steven Low

Recently, I’ve tried incorporating heavier finger rolls as well, as the above linked article references those,

But, I’ve found that the warm-up set is my max weight. Given my pulley problems, I’ve not invested heavily in performing heavy finger rolls and am now exploring lighter weights but lower reps than 30-50, aiming instead for 12 reps — again, with the wrist extended.

Is trying to rehab both issues as the same time a fool’s errand? Should I start with the elbows and continue climbing on weak fingers for the time being or can the two be combined as I’m doing? Am I on the path of likely re-injury or not?

Appreciate any and all thoughts, further discussion, and discourse. I realise my text isn’t well structured or filled with elaborate details welcome follow up questions.

Since the literature supports long isometrics and slow eccentrics - I mostly use those protocols. For my money, keeping some 20-30 second hangs on large edges and 20-30 second, 120 and/or 90 degree lockoffs in the mix is a good idea year round.

I’ve seen the long hangs clear up elbow issues as well, likely depending on why they arose and how you are hanging. I suspect that 30seconds hanging from a large edge with a slightly engaged shoulder/elbow is a good way to promote healthier connective tissue in that whole structure.

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Fwiw I’ve been doing isometric 90 and 120 hangs on a pull up bar to clear up some elbow stuff. Long process but it seems to be working.

I think Tyler Nelson posted a bit on this protocol.

I have often had tennis elbow issues, but not this year.

Last winter I also had a finger injury and spent a lot of time hangboarding on larger edges in various lockoff positions. The finger got better, and I think the lockoffs really improved my elbow health as well

Interesting, is there anything else you keep year round that’s not overtly obvious? I.e., I’d consider the above a not-obvious inclusion, while climbing and hangboarding are obvious inclusions.

I wouldn’t be surprised. I don’t have Instagram, but fortunately have family that keeps me in the loop. To keep with the rules of conduct, I won’t repost the images that were sent to me but a prescription of combining all of the following simultaneously was suggested,

  • Easy ladder-style climbing
  • 45 degree wall
  • 7-8 seconds per hold
  • 30-45s work/arm per set
  • 5-8 sets with 2 minute rest

recently surfed on his Instagram account.

I appreciate your anecdote as well. I just did my first session with the prescription outlined above earlier in my post. As tendons tend to let you know what they feel about you did the next day it is too early to tell but I certainly had a lot of blood crossing the joint. Hopefully, fluid and nutrients ran along the tendon simultaneously.

I don’t think it has to follow this exact protocol per se, (no real reason I can discern to be on a 45 or follow a set/rest scheme) but anecdotally, I’ve been warming up this way for many years (using our Sloth Monkey drills) and I’ve rarely had elbow issues in that time.

Nope, that’s pretty much it. It’s supported by the literature, with a bit of extrapolation as most of what we cite in climbing is. Same place Tyler gets his info - research done mostly by Keith Barr, Ebonie Rio, and Jill Cook.

Sorry Kris, I should have clarified, I didn’t mean for elbows specifically. I realise that might not align with the Code of Conduct for a topic to evolve to have a greater scope than the topic title would suggest so I’ll hope you’ll let me know if this is not how you intend for the community to work.

A non-obvious thing I’ve recently started including is wrist warm-ups in the climbing gym. I’ll happily share the protocol.

Thanks for the concern. I’m fine if topics evolve. No big deal.
The things I keep year round are:

Tension and style drills during my warmups. Specifically various ones from our Applied Body Tension ebook.
I warm up using some variation of the same sequence every time, indoors or out, depending on what I’m climbing that day.
Some sort of strength training in minimal doses, often paired with whatever mobility I feel I might need (all probably less than an hour a week, total).
Lots of climbing.

@Kris @Bolognafingers the 40-45 degree wall thing has to do with shoulder angle, your arms are closer to 90 on a 40 compared to a vertical where they end up more over head. Tyler argues these arm angles are better for recovering a shoulder injury.

I do a daily ritual of 3-4 30s hangs with my feet on, been at this for over 2 years now. Fingers, elbows and shoulders have been great.

Depends entirely on the climb. I can show you lots of footage of the Machine Shop where that’s entirely untrue. That myth should go away.

Also, even if this were the case, it has nothing to do with elbows or pulleys?

Yeah I see what your saying. That’s the way Tyler explained which wall angle and arm angles to use to recover my shoulder. It definitely worked for me. And yes it doesn’t seem tp have anything elbows or pulleys.

I certainly agree that a less severe shoulder angle is the better place to start when rehabbing a shoulder. I think he just got trapped in the myth that vertical climbing is more overhead and 45 is more in front of you.
Hell, I pretty much only climb with my arms stretched out to the side when I have a choice. :rofl:

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Can you elaborate on the details of your daily hangs?

  • On a bar?
    • Supinated/Pronated?
  • On a fingerboard?
  • 90 & 120 deg/same session or alternating days?

With bent-arm hangs, and ladderstyle climbing, I’ve found that I don’t really get any elbow pain except if I’m coming in already aggrevated. Wrist curls, regardless of the load, will trigger my issue which then subsides during the set and becomes better with each subsequent set.

I use a hangboard 30on:30off
-30mm open
-20mm 1/2 crimp
-3 finger drag 25mm
-pinch grip using power strips

Arms are slightly bent at 120 except for during the 3 finger drag for that hang the arms are straight.

In a post a while back I describe a slightly different variation.

I would listen to this podcast EP 67: Heth Jennings — Understanding Pain, Rehabbing Climbing Injuries, and Carb Backloading — The Nugget Climbing Podcast (Sorry for recommending another podcast and the self promotion but I did this rehab earlier this year).

Here’s my Instagram to see how to perform the exercises. I also work with climbers to rehab any injury/issue if you need some extra help.

Good luck!

I’ll give it a listen, thank you!

Can’t see the Instagram link in your post but I don’t have Instagram so it is doubtful I’ll be able to view it anyway.

I’ll try to post the different links here. Maybe it will work

I’m 100% behind this. The only thing that has ever worked for me in the longer-term re: elbow issues is long duration hangs, weighted to the appropriate resistance level - at its worst, I worked with a climber PT and he advocated this approach. I worked up from 12s hangs to 20-30s over a few weeks and now keep the 20-30s hangs periodically in the rotation, especially if I’m starting to feel some elbow/bicep tweaks (usually when I’m ramping up volume of either training or climbing).

Rehabbing a pulley injury this summer/fall, the protocol he advocated was similar, too (although mostly on the 12s hang side of things - like the beginning of my elbow rehab). My PT is a big advocate for pain/discomfort regulated resistance for rehabbing connective tissue injuries (aiming for a specific level of discomfort as a tool to know you’re properly loading the tissues) and I’ve had lots of success with the approach so far.

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