It’s a rare climber that has never experienced a finger, elbow or shoulder injury. In fact, if you’re a hard-training climber fond of pushing your limits, then there’s a good chance that at some point you’ve experienced pain and perhaps injury in all three sites. It’s sad, but true—rock climbing is hard on our connective tissues. (But it’s exceedingly good for our mind, heart, and soul!) So here’s the rub: Even if you’re currently feeling 100 percent injury free, there’s a significant likelihood that one or more of your tendons or annular pulleys is currently in an early stage of pathology, quietly brewing below the nociceptor (pain receptor) threshold. There’s just no way of knowing…
Tendinopathy is an extraordinarily complex disease that’s not fully understood. Google “tendinitis” and you’ll find nearly 8 million results full of conflicting information, including a massive amount of outdated material and bogus remedies. With a discerning eye for recent research and peer-review publications, however, you can gain a truer understanding of the evolution and treatment of tendinopathy. Toward this end, this report strives to cut through the dogma and hokum by distilling the latest research findings into a document that will empower coaches and athletes alike.
So what causes tendinopathy? While this question has yet to be fully elucidated, the leading cause of sports-related tendinopathy is likely a homeostasis perturbation in which collagen degeneration exceeds collagen synthesis over an extended period of time. Among beginning climbers this can develop simply by climbing (and specific training) too much, too soon, or perhaps, due to poor biomechanics. Advanced climbers must navigate an injury mine field as the stress of high-intensity and high-volume training/climbing is compounded by frequent dynamic moves in which tendons repeatedly store and release energy (dynamic moves, campus training, and such).
Therefore, the commonly held idea of tendon injury beginning with a micro-trauma (that eventually worsens or tears) may be wrong in many cases. The genesis of tendinopathy is more likely a localized region of disorganized collagen as a result of lost homeostasis. Initially, intrinsic repair mechanisms may be able to limit the damage and prevent it from progressing to the nociceptor threshold—in this case, without pain sensation, you are totally unaware of the developing tendinopathy. Progression to the “metabolic tipping point” (Figure 5) will correspond with developing pain and, without appropriate modulation of training load and targeted therapy, may eventually progress to tendon disrepair (Figure 6). A final important point: The common A2 and A4 pulley tear almost certainly occurs only in already compromised (disorganized) tissue, irrespective of whether or not the pulley was painful prior to the pulley tear.
It’s important to recognize that, just as with muscles, training is both anabolic and catabolic to tendons. The amount of mechanical loading (volume, intensity, frequency) that’s causative is different for everyone, based on loading history, genetics, and other confounding factors mentioned early. Veteran coaches can tell you how some athletes appear to be completely resistant to tendinopathy despite insane amounts of training (perhaps “overtraining”), whereas other athletes develop recurrent or chronic problems in spite of a cautious, measured approach. Ultimately, training load must be personalized for each athlete so that, along with proper nutrition and adequate rest, the metabolic scale is tipped toward anabolism rather than catabolism.
Athletes and coaches would be wise to monitor tendon health with the same attention paid to muscular recovery and other metrics of fitness. Consider that an elite athlete (or passionate weekend warrior) might lose an entire season or more if a tendinopathy takes hold. Proactively managing training load and nutrition can go a long way to correcting the course toward healthy tendon tissue. In the case of a worsening condition, however, it’s essential to consult a medical professional. There are several procedures that may aid tissue rehabilitation, including extracorporeal shockwave therapy, TENEX, and a well-placed cortisone injection (controversial among physicians).
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