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.
Medial elbow: 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 programme.
In climbing, the elbow rarely fails because of one move. It fails about six weeks after the training block changed.
Anterior elbow: brachialis tendinopathy
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.
The brachialis is a pure elbow flexor sitting underneath the biceps, and it takes disproportionate 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.
The hand one: lumbrical tear
Almost exclusive to climbers, and routinely misdiagnosed as a pulley injury.
It happens on a two-finger pocket, when one finger is crimped and its neighbour 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.
Recovery is generally faster than a pulley — a few weeks to a couple of months — 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.
Loading, which is the actual treatment
- 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 medial elbow, heavy isometric holds usually reduce pain within days and let you keep climbing at reduced intensity.
- Slow eccentric and heavy slow work, 2 to 3 times a week. Wrist flexion for medial elbow, hammer-grip elbow flexion for brachialis. Twelve weeks minimum. This is not a fortnight’s job.
- Change the wall before changing the arm. Less steep ground, fewer pockets, more feet, for six weeks.
- Antagonist work. Wrist extensors, triceps, pressing. Climbers are pull-dominant, and the elbow pays for it.
The climbers who recover are the ones who accept a 12-week programme. The ones who take two weeks off and go straight back onto the board are on their third episode when I meet them.
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, extremely 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
- 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.
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.