insertional biceps tendinopathy and GST

Hey guys,

I got an orthopedic/training question. A few weeks ago I tried out bouldering and became kind of passionate about it, so I kept on visiting the climbing gym on a regular basis (once or twice a week). I've definitely been aware of the fact that my body wasn't really prepared for this new and intense kind of strain, so I tried to listen to my body and go slowly enough. It seems like I didn't, as I developed serious pain in my left arm after a few climbing sessions. I took some days off and when the pain was more or less gone, I went to basketball training, which brought back the pain. Unfortunately I repeated this series of workout -> pain -> rest until pain's gone -> workout -> pain for another week until I recognized it's a problem.

I visited my orthopedic specialist and he diagnosed me with an insertional biceps tendinopathy. He obviously told me to take a break from climbing or any other form of sports which requires arm strength, nevertheless he told me playing basketball is okay. 

It's been one week since I was climbing the last time and the pain is gone, in the meantime I did Core, Lower Body and Lower Body Stretch workouts. I'm rather unsatisfied with my orthopedic's advice as he couldn't really tell me how long I should rest my arm and what "signs" I should look for in order to find out when to start training again.

Is there any form of reasonable guideline on how long to rest? Is it a good idea to start training my upper body slowly (which I would do either way in F1) and just stop when I recognize any form of pain in my arm? What about stretching (especially the TB workout)? This injury really isn't a big thing right now, but I don't want to create a real one by stupidity and impatience;)

Thank you for any kind of advice on this matter;)

HI Ferdinand, you should rest until the pain on the daily activities it is completely gone . then restart with light bicep stretch, isometric hold with elastic band, then partial rom from 90° degree flexion to full elbow flexion. complete rom can be approached only when these range of motion are pain free.

For those that do not already know:

1. Physioworks.com.au What is Tendinopathy?

2. U.S. National Library of Medicine: Treatment of Tendinopathy  

3. WebMD: Tendon Injury(Tendinopathy)

Thank you guys!

I've already been free of pain for the last few days, but I still recognize a little bit of an odd feeling in my left upper arm. 

By the way my orthopedic did ultrasound but found no ruptures or real damage as far as I can remember, so I guess it shouldn't be too severe..I'll do as Alessandro suggested and wait until any kind of strange feeling is gone, then I'll give light stretching and training a try. Until then I'll concentrate on Core and Lower Body;)

From your history (starting climbing a few weeks ago) it seems that this should end up being a light case and that you will be able to go back to "normal" rather quickly once the acute inflammation has settled. 

For future reference, once you have given a week or so of rest to the tendon, you will want to start moving it (eccentric protocols are your best bet for more serious tendinopathies) and rehab should even elicit some pain (as you are doing it, not for an extended time after). A big paradigm shift in sports medicine, but supported by research. Research also suggests that it's best to stay away from NSAIDs such as Ibuprofen. Rather than take my word for it, I recommend the book "Make or Break" which also directs you to some of the research literature if that is your thing.

Good advice above. I'll just add the following: when you begin your upper body protocol again, test only one exercise per workout, and assess afterwards if it is causing the inflammation to flare up again. That way you can isolate the critical exercises, and scale them way down.

I really appreciate your advice, thanks!

Yesterday I went to basketball training and didn't feel any pain while playing, seems like I got off fairly lightly. I'll still take a break from upper body training the next few days and then go forward as suggested. In terms of climbing, I'll probably limit my future climbing sessions to a shorter amount of time and progress slowly and carefully..I think the rope climbing element of GST will be a good preparation for more intense climbing training in the future.

The rope climb PE's and iM's are GOLD for climbing performance. 

Hey guys;)

I paused any upper body training or activities like climbing for some months in order to give my arm the needed time to recover, I just continued playing basketball. I also had some other health issues and basically started my GST journey a little more than two weeks ago. Since then I got in some nice workouts (4x Core, 2x LB, 3xUB, 1x FSS, 1x MSS, 2x TBS and 1x HS). So far so good - I've been pretty sore after the first two Upper Body workouts, the soreness lasted for about 4 days and as I wanted to play it safe, I waited another 1-2 days for the next UB workout. When doing the PE1s, I also concentrated on proper form and never pushed myself to a point, where I reached the absolute limit in terms of muscular strength.

I've been especially sore in my biceps (I guess), in that I couldn't really extend or bend my arms without pain (located on the inside of the elbow). It was that typical "pulling" soreness. It left me a bit puzzled, as I really tried to go slow with the Upper Body workout, as I stated above. But even if it took relatively long, this soreness went away.

Today I had a workout consisting of HS1, Upper Body PE1s and the TBS. It went well and I feel okay, but there's still some "strange" sensation in my left arm (the one with tendinitis 4-5 months ago). I felt the same thing after my last UB workout. It doesn't really qualify as pain, it's more like a slight burning sensation. I feel it in my upper left arm/shoulder, on the outside. When massaging/squeezing the point hard, I can feel the pain (which I don't feel on the right arm, so it's not just me pushing too hard:p). It's on the back-/outside of my shoulder, a few cm's below the joint.

Right now it's not bad at all, but I think it's the same spot as back then with the tendinitis and it feels like it has not fully healed, which I find kinda strange, as I really didn't do any upper body work (just basketball and some regular limbering) for the last 4-5 months. I'm just afraid that the injury is returning..I'm a little desperate, as I've been to my orthopedist with this issue before and I'm also going to physiotherapy at the moment, but both don't seem to be able to really help. 

What's my line?=D Continuing GST the way I'm doing right now, as long as all the soreness goes away within a few days? Or is there anything I can do to be sure about the tendinitis thing not returning?

I'd be grateful for any advice!

Hi Ferdinand,

I'm glad you reached out about this issue. My first suggestion is to visit a medical professional. An in-person diagnosis is the best place to start. In the meantime, until you have the suggestion of a medical professional, stop training any exercises that cause pain, irritation, or abnormal feelings in your elbow. 

Once your elbow is completely healed and you begin training again, adjust your weekly schedule so that you perform each workout only once per week. Do this for at least one month before adding in any additional handstand, core, UB, or LB workouts into your weekly schedule.

As a reminder, the stretch courses are not supposed to be trained more than once per week each. The TBS 2x per week is too frequent. Your body needs more time to recover from deep stretching.  

Hi and thanks;)

The workout numbers above describe what I've done over the whole two weeks since I started, so I only did the TBS once per week! Same with the Upper Body, I basically rested for 6 days because I've been sore relatively long plus wanted to play it safe - when I worked out, there was no pain/soreness whatsoever! I don't have any problems with the other courses.

I guess the elbow "thing" would qualify as normal soreness after training, what's concerning me is the slight burning sensation below the shoulder..

I'll visit my orthopedist again as soon as possible, but I'm not too optimistic he will be able to do much, as he hasn't been the last times I've been there..though I think he's competent. It's just frustrating, I'm definitely not going to provoke an injury again, but I thought I've been patient enough resting plus it felt good to get back on the tracks, I don't want to leave them just now;)

I'll keep you updated!

Edit: Did some research again on the injury..I'm reading a lot of stuff about degeneration of the tendon. That doesn't sound motivating;)

4 hours ago, Ferdinand Berr said:

Hi and thanks;)

 

The workout numbers above describe what I've done over the whole two weeks since I started, so I only did the TBS once per week! Same with the Upper Body, I basically rested for 6 days because I've been sore relatively long plus wanted to play it safe - when I worked out, there was no pain/soreness whatsoever! I don't have any problems with the other courses.

 

I guess the elbow "thing" would qualify as normal soreness after training, what's concerning me is the slight burning sensation below the shoulder..

 

I'll visit my orthopedist again as soon as possible, but I'm not too optimistic he will be able to do much, as he hasn't been the last times I've been there..though I think he's competent. It's just frustrating, I'm definitely not going to provoke an injury again, but I thought I've been patient enough resting plus it felt good to get back on the tracks, I don't want to leave them just now;)

 

I'll keep you updated!

 

Edit: Did some research again on the injury..I'm reading a lot of stuff about degeneration of the tendon. That doesn't sound motivating;)

Ive been doing research myself re Tedinopathy. Google; Jill Cook Tendon.

She's a professor who specilises in Tendinopathy.

Don't get wrapped up in negative images elicited by terms such as "tendon degeneration". Tendinopathies respond to treatment, e.g. eccentric exercise slightly above the pain threshold - but not to rest only. As another free resource, you could look up and listen to the episodes with physical therapist Esther Smith on the TrainingBeta podcast. She explains the rationale behind going past some pain threshold (the need for it). Esther Smith also has a website with self treatment protocols, currently for elbow tendinopathies only. 

You might also just feel unusual soreness or "trigger points" from restarting the GB program full on. I have had that in the past and one instance (I think it was trigger point/deep soreness in the medial deltoid) felt like what your described for pain somewhat deep in the outside of the shoulder.

@Greg White that leads to some great resources, thank you!

Thank you guys for all the information, I'm going to read up on it!

Perhaps I've rested too much during the last months, as I said I've just been playing basketball and doing some light limbering for my basketball warm-ups, but absolutely no strength training or upper body stretching whatsoever.

Right now I don't feel any noteworthy soreness from yesterday's UB, HS and TBS workout, just that very slight sensation around/below the shoulder. Perhaps it's coming with some delay tomorrow, but I think it's kind of strange that there's hardly any soreness today, when I've been extremely sore for 4 days after the last workout of that kind, intensity didn't really change too much. 

I'm going to keep the slow pace when it comes to Upper Body training and read up on all the information you pointed out to me, thank you!