ASK DR J – ISSUE 207 – TENDON TRUTHS

Last fall I injured the supinator muscle in my right arm slightly while climbing. This led to radial nerve impingement. A couple months off and physical therapy took care of the problem. But while I was in pain from the injury, I had to continue working, which involves a lot of laptop time. I am not sure how—whether from compensating or just coincidentally—but I gradually started having elbow pain on the outside of my elbow. A doctor administered a cortisone shot, which took the pain away completely. My arm was weaker but I was able to climb without pain for several months. Now I’ve had pain again for a couple months with some specific movements, such as pinching a tube of chapstick, picking up a frying pan, or trying to side-pull on a high hold.

Lena1 / rockandice.com forum

That you have elbow tendonosis is fairly apparent. Whether it afflicts the supinator or one of the extensors is up for debate. However, administering cortisone is not only nonsense, it is thoroughly debunked nonsense. I’ll go handbags at 10 paces with anyone who says otherwise.

You need some testing on your elbow to decide which tendon is afflicted. Have a read of the “Dodgy Elbows” article in No. 156 or see it on drjuliansaunders.com. In terms of testing, pay particular attention to the angle of your elbow. Start with your elbow straight and test every 30 degrees or so, until it is fully flexed. Go through the eccentric testing protocol for the exercise shown in the Frying Pan Sessions video recently described in No. 201 (also on my web page).

Additionally, test the supinator by holding the frying pan vertically and letting it slowly fall into pronation. Again, start with your elbow straight and test through the whole range. You are your own little barometer of effectiveness, and pain is the measurement of success. Pick the worst angle and do three sets of eight to 10 reps morning and night, every other day.

 

Watching the Olympics earlier this month, I noticed that many athletes, from sprinters to basketball players, wore compression sleeves. Might there be any benefit to climbers from wearing them?

Lyzrdo / rockandice forum

Although I prefer my hosiery to be of the fishnet variety, compression-stocking fashion is spreading like a virus in the sports world with only weak scientific support. Once restricted to the wardrobes of people with compromised circulation and Freddie Mercury, athletes are now using these formfitting garments to purportedly reduce the incidence of injury, increase performance and assist recovery.

The study most often quoted refers to an increase in performance of about 1.5 percent. Not a particularly significant number, I’d suggest, given all the other variables of climbing. There is also a bit of noise surrounding perceived improvements in recovery, but neither claim is well supported in the literature. But let’s not allow science to get in the way of the retail sector.

Actually, some evidence out there supports the notion that compression can reduce lactate levels during and post exercise, but there has been very little replication of previous studies. It is probably safe to say that lactate levels during performance may be reduced by compression, depending on the level of pressure. Too low and you’ll get no effect, too high and you slow circulation making lactate levels worse.

A reduction in the incidence of injury is quite likely, though, given that the stocking should keep your muscles warmer. That said, I don’t see too many acute injuries of the forearm or elbow, for example, where warmth could be a mitigating factor.

A while back I was having trouble on a project. I was close, but had been for quite some time. A friend told me to think of something that makes me happy as I headed into crux. Naturally, I reflected on my Hottie and although my fantasy involved stockings it was not the ones we are discussing here. Nonetheless, it worked, and I sent that puppy the very next go. My point being that for small gains in performance, there are loads of options! Many are cheap to the point of being priceless.

 

I thought floss bands were underwear chicks wear that go up their cracks but then I saw an online video about Voodoo Floss Bands, a compression sleeve and type of mobilization used to fix dodgy elbows. What do you think?

Chris Parker / Carbondale, Colorado

Floss bands are a type of tourniquet applied over a joint. “Flossing” refers to jerking a joint through its range of motion. This “therapy” is gaining popularity among some athletes, mainly body builders.

Anything involving the word “voodoo” in a medical context creates an instant credibility conundrum. Add the word “floss” and the mind boggles. Maybe it’s just me, but the name conjures imagery of medieval witch doctors, G-string-wearing tyrant queens, and dental torture by nurses in costume. A simple solution to elbow tendonosis? Well, I hope Mack, the victim in the video, made a wish before allowing his elbow to be splayed like that.

Nonetheless, I can see where the narrator is going in terms of reinstating the normal range of motion. I am not too sure how the tourniquet works in the process other than as a weak preventative measure against snapping ligaments. It does fulfill the role of “magic box” placebo. A more measured approach without the Voodoo G-string (but with a medical professional) would probably be just as effective with a lot less risk.

The real issue with the video is that the words tendonitis and tendonosis are used interchangeably, which is akin to comparing whooping cough with a runny nose in terms of disease process and prognosis. Call me persnickety. This treatment (and I use the term loosely) could possibly free up tight tissue around the elbow and might help reduce some factors that lead to elbow pathologies, though I doubt it is a solution for even a mild case of tendonosis. God forbid you had a minor tear in the tendon, because it would get a whole lot worse.

And who do you get to do the mobilization? Your mom?