So here we are, the second chapter on the pathology and prevention of injuries in sport climbing. In this section, we will discuss the elbow (the first one was about hand injuries), from the anatomical, biomechanical pathology and preventive point of view.

From the functional point of view, the elbow is the element that allows the hand to move both to and from the body. Therefore, the main feature is the flexion-extension and pronation-supination. In this specific area, as mentioned in the previous chapter, the majority of the contractile components with action to the hand are found. And therefore the logical connection is created between the elbow and hand from an anatomical and a biomechanical pathology point of view.

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From an anatomical point of view, in the medial compartment of the elbow, the insertion of the apparatus flexion of the wrist and fingers can be found, and also the passage of the ulnar nerve can be found. Whereas in the lateral compartment of the elbow, the insertion apparatus extensor can be found and between a fascial arch of muscle the passage of the radial nerve and its branches can be found. The proximity and the anatomical structure of the tissue and nerve make up the neural compression control center of the elbow resulting in painful symptoms, or worse still, pins and needles, numbness and lack of strength.

Also in this chapter, the pathologies deriving from it are well known by climbers. The classic and well-known medial and lateral epicondylitis are more often than not the pathologies with which the climber learns to live with and over time, it can become chronic.

The overuse of the extensor and flexor apparatus affects the quality of the connective tissue that can result in the possibility of nerve compression.

Therefore, from this biomechanical pathology explanation derives the need to have a good elongation of the soft tissue of the elbow.

But only the biomechanical pathology specific to the elbow is not enough. However, it does explain the continuation of the symptoms at the elbow. In fact, many people, even those following a good rehabilitation program “specific” to the elbow, aim to improve the elasticity of the flexors and extensors, even though the pain does not completely disappear. The data present in literature talks about a “double nerve entrapment”, most of the time in the cervical area. It is therefore, necessary to have good muscular mobility and balance on all of the upper limbs and the cervical spine.

Physiotherapy treatment differs if the patients present themselves in the acute or chronic phase. The pain is defined as chronic when symptoms continue for more than 3 months.

In the acute phase, the best treatment is as follows:

• Rest
• Painkillers (by prescription)
• Rehabilitation
• Icing to the specific area

Chronic Phase:

• Practical bandage (Kinesio taping)
• Rehabilitation
• Stretching, firstly dynamic and then static
• Muscular reinforcement

Just like in the previous chapter, the basic rules to prevent any type of injury in climbing, but also in other sports are: proper preparation, dedicate a reasonable amount of time to the warm up phase with a proportionate and progressive training at the point when the physical warm up begins. Be sure to have an appropriate balance between agonist and antagonist muscles and good muscle-tendon flexibility.

In the warm up phase, as well as the exercises presented in the previous chapter, it is recommended to integrate with the following:

– Dynamic stretching for the mobilization of the radial nerve and the ulnar nerve;

Position 1: Flex the head in an ipsilateral direction, rotate the arm and elbow and clench your fist.
Position 2: In a contralateral direction flex the head and return to a neutral position with the arm, forearm and hand.
Repeat 10 times dynamically.

Position 3: Head flexed in an ipsilateral direction and bend the arm back 90 degrees, elbow bent, hand resting on the head.
Position 4: Head flexed in a contralateral direction and bend the arm back 90 degrees, elbow extended, hand flexed.
Repeat 10 times dynamically.

– Strengthening of the triceps

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3 sets of 15 repetitions.

The exercises listed above must nevertheless be regarded as exercises for prevention. In the case of any pain or pins and needles etc., it is advisable to refrain from these types of exercises and only continue after an evaluation from a physiotherapist or medical staff.

Enjoy your training
Silvio Reffo