Climbing places significant demands on the fingers, forearms, elbows and shoulders. Whether you're working through a difficult boulder problem or spending a long session on the wall, these tissues are repeatedly exposed to high levels of load. As a result, overuse injuries are among the most common injuries experienced by climbers.
One of the more common presentations is pain around the inside of the elbow, often referred to as “climber’s elbow.”
Climber’s elbow (also known as golfer's or tennis elbow) refers to pain around the medial, or inside aspect of the elbow. It is commonly associated with medial epicondylalgia, where the tissues around the medial epicondyle become sensitive to load.
Symptoms often develop gradually rather than from one specific incident. Pain may be noticed during gripping, pulling or climbing and can become more noticeable as climbing volume or intensity increases.
It is important to recognise that medial elbow pain can have several contributing factors, so the exact diagnosis can vary between individuals.
The medial epicondyle is the bony prominence on the inside of the elbow and serves as an attachment point for several muscles of the forearm, commonly referred to as the flexor-pronator group.
These muscles are responsible for movements including wrist and finger flexion, forearm pronation and gripping. These same muscles are placed under considerable demand during climbing, particularly during sustained gripping and pulling.
Repeated exposure to high loads can challenge the capacity of these tissues, particularly when training demands increase faster than the body can adapt.
Climber’s elbow is often related to a mismatch between the load being placed on the tissues and their current capacity to tolerate that load.
This can occur following a sudden increase in climbing frequency, intensity or duration, climbing harder grades, introducing additional finger or strength training, or returning to climbing after a period away. Insufficient recovery between sessions can also contribute.
Rather than being caused by one particular movement, medial elbow pain is often the result of cumulative loading over time.
The goal isn't to avoid loading the elbow. Instead, the aim is to gradually build the capacity of the muscles and tendons to tolerate the demands of climbing.
A progressive warm-up can help prepare the fingers, forearms and upper limb before climbing. This can include moving through comfortable ranges of motion, followed by light strengthening and grip-based exercises to progressively prepare the tissues for the demands of climbing. The intensity can then be gradually increased as you transition onto the wall, rather than going straight into climbing without preparation.
Screenshot this warm up routine to try before your next session on the wall.
Strength training for the forearm, wrist, grip and broader upper limb can help develop the capacity required for climbing. Exercises should be progressed gradually alongside your climbing load, with the aim of building strength and improving your ability to tolerate repeated gripping and pulling.
Load management is equally important. Increasing climbing volume and intensity progressively, allowing adequate recovery between sessions and being mindful of sudden changes in training can all help reduce the likelihood of an overuse injury.
Soft tissue work such as massage or using a ball around the forearm can also be useful for managing muscle tension and symptoms. Taping can also be used in some cases to provide additional support and help reduce symptoms during climbing. However, these strategies are best used alongside progressive strengthening and appropriate load management rather than as a standalone solution.
An elbow injury doesn't necessarily mean you need to stop climbing completely. In many cases, the goal of rehabilitation is to modify the load rather than remove it altogether. You might also consider some other types of exercise to mix up your weekly routine. Try a yoga or circuit class next time you're at the gym.
If your pain isn’t improving after a few weeks of modifying your load, is getting worse, or comes with numbness, tingling or swelling, it’s worth booking in to see a physio.
At Any Stage Physiotherapy and Sports Medicine, we take this approach to rehabilitation across a range of musculoskeletal and sporting injuries. As an upper-limb focused practice, we work with climbers and athletes, as well as the broader community, helping people understand their injury, build capacity and get back to doing what they enjoy.
Through our collaboration with Climb Fit, we’re excited to support the climbing community through education, injury prevention and physiotherapy.
Keep an eye out for Any Stage Physiotherapy pop-ups at Climb Fit, where we'll be providing education, injury advice and physiotherapy assessments.
Drew Sellers – BSpExSc, DPT, APAM
Physiotherapist , Anystage Physiotherapy and Sports Medicine
