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Climbing Elbows Don’t Need Rest. They Need a Program.
Climber’s elbow (inner-side pain) and brachialis pain (deep in the front of the elbow crease) usually need at least 12 weeks of progressive loading, and full board and hangboard training often takes 3 to 6 months to come back. A lumbrical tear in the palm typically takes 4 to 6 weeks for a mild strain and 8 to 12 weeks for a bigger tear, with two-finger pockets returning last.
Climbers get two elbow problems and one hand problem that pulley injuries don’t cover, and all three are load problems rather than accidents.
Climber’s elbow is medial, not lateral: inner-side pain from pulling, not outer-side pain from gripping. And the deep ache in the front of the elbow crease is usually the brachialis, a muscle almost nobody thinks about until it stops them climbing.
Get the plan wrong and you know the loop already. Two weeks off, straight back onto the board, sore again by week three. Repeat until a six-week problem has eaten a whole season.
What is climber’s elbow?
Pain on the bony point on the inner side of the elbow, worst on steep ground, undercling moves, and anything requiring a locked-off pull.
Mechanically it’s the same tendon problem as golfer’s elbow: the finger flexors and pronator anchoring onto the medial epicondyle, overloaded.
What makes it a climbing problem is the volume. Three sessions a week of maximal finger flexion, every session, for years, with a jump in intensity when someone starts a board or a hangboard program.
In climbing, the elbow rarely fails because of one move. It fails about six weeks after the training block changed.
Why does the front of my elbow hurt from climbing?
A deep, hard-to-point-at ache in the front of the elbow crease. Worse on lock-offs and campusing. Often described as feeling “inside” the joint rather than on it. That’s brachialis tendinopathy.
The brachialis is a pure elbow flexor sitting underneath the biceps, and it takes a big share of the load in climbing positions. It’s slow to settle and it responds well to controlled, heavy, slow-tempo elbow flexion work… which most climbers do none of.
The one thing to exclude: a sudden pop at the front with weakness turning the palm up is a distal biceps rupture, which has a repair window measured in weeks. Gradual ache, tendinopathy. Sudden pop, hospital.
Is it a lumbrical tear or a pulley injury?
Lumbrical tears are seen mostly in climbers, and they’re routinely misdiagnosed as a pulley injury.
It happens on a two-finger pocket, when one finger is crimped and its neighbor is extended. The small lumbrical muscle between them gets stretched between two tendons moving in opposite directions, and tears.
The distinguishing feature: the pain is in the PALM, not in the finger, and it is reproduced by the exact pocket position that caused it. A pulley injury hurts on the finger itself, usually with a pop at the moment of injury.
How are these diagnosed?
- Medial elbow: tender right on the inner bony point, and the pain comes back when you resist bending the wrist or turning the palm down.
- Brachialis: pain when you resist bending the elbow with the palm facing down or sideways (that position takes the biceps partly out of the job), and deep tenderness in the crease.
- Distal biceps: a pop, bruising in the crease or forearm, weakness turning the palm up. A surgeon can check whether the tendon is still attached in seconds, and an ultrasound or MRI confirms it.
- Lumbrical: palm pain when one finger is held bent while its neighbors are held straight. Normal finger strength in a full fist.
- Pulley: tenderness at the base of the finger, pain crimping, and sometimes the tendon visibly lifting away from the bone. Ultrasound is the usual scan when a rupture needs ruling out.
How long does climber’s elbow take to heal?
Typical ranges when the loading is done properly. Your clinician’s plan comes first.
- Weeks 0 to 2: isometrics daily. Easy, vertical terrain, open-hand grips, no board, no campusing, no lock-offs.
- Weeks 2 to 6: heavy slow resistance 2 to 3 times a week. Climb a few grades below your limit, still off steep ground.
- Weeks 6 to 12: steeper ground comes back gradually. One short board session a week if the elbow stays settled the next morning.
- Week 12 onward: hangboard and campus last, in small doses. Full training load is often a 3 to 6 month job.
Brachialis runs on a similar clock: 8 to 12 weeks of loading for most, longer if it’s been ignored for a season.
Here’s the window. Tendinopathy is OPEN: time is on your side as long as the loading is right, and nothing slams shut if it takes 4 months instead of 3. The one that runs CLOSING is the distal biceps rupture. Repairs are most straightforward in the first few weeks, cos the tendon retracts and scars down after that. Pop plus weakness means see someone this week, not after the comp.
How long does a lumbrical tear take to heal?
Recovery is generally faster than a pulley, provided you stay off pockets. Go back to pockets early and you re-tear it, repeatedly, which is how a six-week injury becomes a season.
- Weeks 0 to 2: no pockets. Pain-free open-hand climbing on jugs only if the palm stays quiet. Full fist and hook fist, 10 slow reps, 2 to 3 times a day.
- Weeks 2 to 6: crimps and slopers on vertical terrain. Still no two-finger pockets.
- Weeks 4 to 12: pockets return, three-finger first, two-finger last, on big holds at low load. Mild strains are usually here by week 4 to 6; bigger tears need nearer 8 to 12.
- The rule throughout: pain up to about 3 out of 10 while climbing, settled by the next morning. Worse the next day means drop back a step.
What exercises help climber’s elbow and brachialis pain?
- Don’t rest completely. A tendon rested for six weeks comes back weaker into the same climbing volume. That’s the loop most climbers get stuck in.
- Isometrics early. For the medial elbow: wrist-curl position, hold a dumbbell still, 30 to 45 seconds, 5 holds, once or twice a day. Heavy isometric holds usually reduce pain within days and let you keep climbing at reduced intensity.
- Heavy slow resistance, 2 to 3 times a week. Wrist flexion for the medial elbow, 3 sets of 8 to 12, 3 seconds up and 3 seconds down. Hammer curls (palm facing in) for the brachialis, same sets and tempo. Twelve weeks minimum. This is not a two-week job.
- Pronation. Hold a hammer by the handle, forearm on a table, slowly rotate palm down and back. 3 sets of 15, every other day.
- Change the wall before changing the arm. Less steep ground, fewer pockets, more feet, for six weeks.
- Antagonist work. Wrist extensors, triceps, push-ups or pressing, 3 sets of 10 to 15, twice a week. Climbers are pull-dominant, and the elbow pays for it. See golfer’s elbow exercises for the full progression.
The climbers who recover are the ones who accept a 12-week program. The ones who take two weeks off and go straight back onto the board are on their third episode when I meet them.
Doing aerial or pole as well? See pole dancing and aerial.
Go to the ER or call a surgeon today if
- A pop at the front of the elbow, then bruising and weakness turning the palm up, or the biceps bunching up toward the shoulder.
- A fall off the wall and the elbow looks deformed, won’t bend or straighten, or the hand goes numb, cold or pale.
- A loud pop in a finger with immediate swelling, or the tendon bowstringing away from the bone when you bend it.
- A hot, red, swollen elbow or finger, especially with a fever.
Get it assessed if
- There was a pop, and something is now weak rather than sore.
- Any numbness or tingling in the ring and little fingers. That’s the ulnar nerve, common in climbers who sleep with bent elbows.
- Elbow pain hasn’t improved after 12 weeks of proper loading.
- A finger pocket injury that keeps recurring every time you return.
- The elbow catches or locks, or you’ve lost the last few degrees of straightening.
- Pain at night or completely at rest.
Climbing elbows and hands don’t need rest. They need a program, and the program is unfortunately just a tad longer than anyone wants it to be.
Written by Nigel Chua, hand occupational therapist in practice since 2005. Thousands of hands, wrists and elbows assessed and treated. My credentials are here. This article explains; it doesn’t examine. A pop with weakness at the front of the elbow deserves a surgeon this week, not a rest day.
Part of: Hand, wrist and elbow pain by job, sport and hobby
Every article on this site is written using the Closing Window Method: name the window your condition runs on, find where you are in it, and act while it’s still open.