If you are a climber you have probably either heard of or experienced climber’s elbow. This injury is caused by overuse or acute injury and subsequent tendonitis of the brachialis muscle (refer to Diagram A). When rock climbing there is an ongoing battle between the supinating action of the biceps pulling and the necessity to maintain a pronated hand position to maintain grip on the rock wall.
While injury of the brachialis muscle has been coined “climber’s elbow”, it’s an increasingly common injury for other sport activities, especially high intensity workouts (ones that incorporate speed and heavier levels of resistance). Pull-ups and chin-ups, that are common in cross fitness programs, are known to be associated with brachialis injury at the elbow.
Whether your elbow injury is caused by too much climbing, high intensity weight training, or another related stressor, your Chiropractor can be vital in diagnosis, treatment, and recovery.
Brachialis muscle shown in red
Accurate diagnosis is a key first step in the in the injury recovery process. There is more than one muscle in front of the upper arm. Treating the wrong structure will limit full recovery. For instance, it’s important to rule out the more common bicipital injury. This can be done through the Chiropractor’s hands on assessment during flexing of the elbow and supination of the wrist. Tenderness in this movement is usually present with Bicipital injury but not with the Brachialis until resisted elbow bending occurs.
Treatment typically has three phases. Phase I, the acute phase, focuses on relieving pain and reducing inflammation. The first step is to discontinue the activity that caused the injury. We know that can be very challenging for avid athletes but this is necessary. In this situation it’s especially important, since offending activities require lifting of one’s entire body.
Such a great strain compounds the risk of further injury. Controlling inflammation can be done using ice, electrical stimulation, and/or ultrasound. Cautious and gentle use of instrument-assisted soft tissue work can also help accelerate this phase.
Phase II, Sub-acute phase
This is when Active Release Technique and Chiropractic adjustments play a larger role. Active Release Technique is used on tightened tissue to restore flexibility to the tissue, help improve oxygenation and hence speed healing. Chiropractic adjusting of the affected joints in the kinetic chain (a sequence of structures working together to create a particular movement) helps restore the injured area by ensuring that everything is working together. This promotes correct alignment and helps prevent re-injury. Taping or using a brace is typically necessary when daily activities are difficult. The goal here is to limit full extension of the elbow.
Recovery, Phase III
Recovery for any sports enthusiast is all about returning to the sport. The reengagement process is a critical step that requires a solid plan. Out of necessity it’s a graduated process, not solely based on pain but rather on the restoration of function and tolerance during and after activity.
The most likely cause of re-injury would be returning to intense activity too soon. There is no standard recovery time since each athlete is unique. It is a Chiropractor’s job to determine the most effective return to sports, which will ensure a timely and complete recovery.