Elbow Tendon Pain in Climbers: A Guide to Golfer’s, Tennis and Climber’s Elbow Recovery

Introduction

If you’ve been climbing for a long time, you’re likely familiar with the tender/aching feeling on the inner or outer part of your elbow from time to time. It can often occur during periods of more intense training, projecting hard routes or after returning to climbing after a break.

This kind of tendon pain is usually described as Golfer’s, Tennis or Climber’s elbow, but can also be referred to as tendinopathy, tendinitis or epicondylalgia. It can develop slowly over time as a low-level, “annoying” pain, or it can be intensely painful after a particularly challenging session. Either way, it leaves you with a very painful elbow that aches and keeps you awake.

With a structured plan, this kind of injury is quite simple to rehab, despite being a very painful and limiting condition that can hold you back from enjoying your climbing. This guide breaks down what you need to know about elbow tendon pain - what it could be, how to treat it, and how to come back stronger.

What Is Golfer’s, Tennis and Climber’s Elbow?

Golfer’s Elbow (Medial elbow pain): Pain on the inside of the elbow, where the wrist and finger flexor tendons attach. This is the more common version in climbers due to the high demand on the forearm flexors during gripping.

Tennis Elbow (Lateral elbow pain): Pain on the outside of the elbow, where the wrist and finger extensor tendons attach. Slightly less common than medial elbow pain but often just as frustrating.

Climber’s Elbow (Central elbow pain): Pain in the middle of the elbow, just below the bicep in the crook of your elbow. This kind of elbow pain becomes more common as dynamic settings and steeper climbing increase, often leading to greater load on the biceps.

Often referred to as Tendinitis, they are often not related to inflammation (Itis = inflammation). They’re more often than not Tendinopathies, meaning the tendon has become disturbed, grumpy and intolerant to load due to constant overload. 

Causes and Risk Factors

Here’s why climbers are vulnerable to elbow tendon pain:

• “Overuse” and Load Mismanagement: Repetitive gripping, pulling, and hanging can overload the forearm tendons when the load is not progressed appropriately, or adequate recovery is not had.
  
• Inefficient Technique: We've all been, or seen, that climber who relies heavily on upper-limb power and strength to make it up the route. This contributes to the above issue of overloading the tendon.
  
• Training Errors: Accelerating training load too rapidly and or introducing too many new training methods in an effort to improve quickly increases the risk of tendon overload.
• Shoulders and Wrists: Limited mobility and/or strength in the joints on either side of the elbow can increase loads on those tendons, causing irritation.
  

Symptoms to Watch For

• Aching or Burning Pain: Localised to the medial (golfer’s) or lateral (tennis) epicondyle (prominent bones on either side of the elbow), especially after sessions or in the morning.
  
• Pain When Loading: Different grip positions can aggravate these injuries. Take note of which types of holds cause the most issues, as they can help identify which structures are most likely contributing to your issue.
• Tenderness to Touch: Pressing on the inside or outside of the elbow, around the bone and tendon area, reproduces pain.
  
• Reduced Grip Strength or Endurance: You might notice you aren’t able to ‘put the power down’ on the injured side, not be able to hold things you normally can or get pumped more quickly.
  
• Warm-up effect: These tendon-related issues often feel quite tweaky before you’ve warmed up, so you might not notice them during your session. Once they cool down (post-session), you often notice the symptoms return.

How Physiotherapy Can Help

A well-structured plan will make a big difference when it comes to resolving this kind of issue – not just managing the symptoms! We often focus on:

1. Load Management and Activity Modification

• Reduce or modify climbing volume and intensity to a tolerable level which doesn’t provoke your symptoms.
  
• Avoid aggravating moves/positions (e.g. lock-offs, compression, full crimping – it depends on your type of tendon pain).
  
• Reduce more aggressive climbing styles in favour of controlled, intentional movement. Temporarily reducing board climbing and steep-roof climbing can be useful for some in the early stages of recovery from this injury.
  

2. Tendon-Specific Strengthening

• Tendons need load to heal. The load needs to be the right kind, the right amount and at the right time to be effective.
  
• Start with isometrics to reduce pain, then gradually progress to eccentric and concentric loading to rebuild tendon capacity.
  

3. Full Kinetic Chain Support

• Strengthening the shoulder, scapular stabilisers, and the wrist helps offload stress from the elbow during climbing.
  
• Getting some movement coaching can dramatically improve your technique, often reducing the loads on your elbows when climbing.

Practical Rehab Exercises (with General Progressions)

Note: Exercises should be performed at a tolerable symptom level and are done at the right level when they don’t make the symptoms worse after or the next day.

1. Isometric Wrist Flexion/Extension Holds

 Why: Reduces pain and kickstarts tendon loading in a safe, controlled way.
 How:

• Sit or stand with your forearm supported.
  
• Hold a dumbbell in your hand.
  
• For golfer’s elbow: hold the wrist in flexion (palm up)
  
• For tennis elbow: hold the wrist in extension (palm down)
  
• Contract gently and hold for 20-30 seconds.
  
• Perform 3–5 sets daily. Pain should be ≤ 3/10, or whatever is tolerable for you.

Progression: Gradually increase weight and hold time as tolerated. If isometrics are no longer triggering pain after several weeks, progress to the full range of movement up and down (concentric and eccentric movements).

2. Forearm Supination and Pronation with a Top-Heavy Dumbbell

Why: Builds control and strength in the rotational muscles of the forearm, which help stabilise the elbow during climbing.
How:

• Sit down, resting your forearm on your thigh or on a bench. Your wrist should hang off the edge.
  
• Use a hammer-style or top-heavy dumbbell (loading pins with barbell clips work well).
  
• Slowly rotate the forearm from palm up (supination) to palm down (pronation), controlling the movement in both directions.
  
• Perform 2–3 sets of 10–12 reps, 3–4x/week.

Progression: Increase range of motion or weight as strength and symptoms improve.

3. Isometric Pull-Up Lock-Offs

Why: Builds elbow and shoulder strength in climbing-specific positions.
How:

• Use a pull-up bar, jugs or slopers (choose whichever grip feels like it targets your symptoms the most).
  
• Pull to 90° elbow flexion or the lock off position that triggers your symptoms the most. Hold statically for 10-30 seconds.
  
• Keep your shoulders engaged and scapula down.
  
• Perform 3-5 sets, 3 to 4 times a week.

Progression: Gradually increase hold duration, add weight, or shift to smaller holds.

4. Scapulothoracic Strength and Stability

Why: Supports healthy shoulder function and therefore supports the elbow joint in tolerating complex upper limb movements.
How:

• Use weights for rows, external rotations, and overhead pressing movements.
  
• Focus on full scapular movement throughout – don't ‘over engage/retract’
  
• Perform 2 to 3 times per week as strength sessions. Aim for 2 to 3 sets of 6 to 10 repetitions of each.

Progression: Add resistance or increase time under tension as control improves.

Load Management Tips for Elbow Recovery

• Track Symptoms and Training: Monitor climbing volume, intensity, and elbow symptoms daily.
  
• Respect the Pain but don’t let it take over: Allowing for some tolerable symptoms – the ones that resolve quickly after you stop loading the elbow – is ideal, and avoiding the symptoms that reduce your capacity to tolerate load the next day/session.
  
• Modify Grips: Initially, it can be helpful to avoid the grips that aggravate your symptoms. As the injury improves, we aim to reintroduce them to your climbing gradually.
  
• Session Volume: Start with shorter, lower-volume sessions and gradually build back intensity before adding session volume.

When to Seek Professional Help for Elbow Tendinopathy 

As useful as some of these principles and recommendations can be, people often struggle with elbow pain and either make it worse or plateau in results. 

Here’s when it might be time to see a climbing injury specialist: 

• Pain persists beyond 6 to 8 weeks despite consistent rehab
• Symptoms interfere with normal tasks (like holding a mug or brushing your teeth
• You have weakness, numbness or tingling 
• You're unsure how to progress or modify training safely

Book an appointment now online: https://whitehouseclinic.connect.tm3app.com/book/sheffield_climbing_clinic

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Final Thoughts

Elbow pain is often difficult to manage for climbers because there are many contributing factors, and our elbows bear a lot of load when climbing/training. With a simple, consistent and patient approach, many people can resolve these issues and get back to climbing at their limit.

If you’ve found this helpful and know someone who may benefit from this article, send it their way!