How to diagnose and treat inner elbow pain (Medial epicondylalgia)

Elbow pain… you may have heard of it. It starts with a little nagging ache after one too many attempts on your project. You brush it off, it hides away for a while, but then, sneakily, it comes back. And this time it’s not playing around. The pain’s now that friend crashing on your couch for too long, showing up strong after each session and sticking around for days.

Maybe you’ve actually tried resting for 2 weeks (4 weeks?! Unheard of!) Just when it feels like it’s easing off and you’re convince it’s safe to climb again, that elbow pain is waiting to greet you like an old (shitty) friend.

You’ve tried to change things up: easing off on those nasty crimps, avoiding compression movements, steering clear of slopers, maybe even giving your forearms a good self-massage before and after climbing. Yet, the pain just won’t quit.

Elbow pain is super common among climbers and often the reason for taking unwanted breaks from the sport. The two most affected areas are the outer elbow (lateral epicondylalgia) and the inner elbow (medial epicondylalgia). At Rock Rehab we’re elbow pain experts. We understand the real reasons behind those aching elbows and how to optimize the things you’ve already been doing to manage it. Climbing-related elbow pain can be annoyingly persistent and tricky to deal with, but we’ve got the lowdown on why it happens and, more importantly, how to fix it.

Let’s zoom in on medial epicondylalgia (the outer elbow). Often dubbed “golfer’s elbow”, which is cute, but let’s be real, climbers put way more strain on their elbows than golfers. Our elbow pain occurs at the intersection of a project that is too difficult for our ability and a psych level that is too much for your tissues.

What’s happening here?

Medial epicondylalgia usually boils down to a tendinopathy in the common flexor tendon, but it can also hit tendons like the flexor carpi radialis, flexor digitorum superficialis, or pronator teres. These muscles connect to the medial epicondyle of your humerus and tend to get all riled up during climbing or heavy lifting. Their job is to help stabilize the wrist, fingers, and elbow during movement, but when overused—whether from too many tiny holds, grip-intensive activities, or just straight-up muscle weakness—these tendons can get irritated. Over time, that irritation turns into tendinopathy, which means the tendon starts to break down.

Here’s the deal:

climbers often have seriously strong finger flexors, but the muscles that stabilize the wrist? Not always as strong. So, when you’re projecting (and maybe even sending every so often), those wrist stabilizers can’t keep up with the demand, and things start to go south, leading to elbow pain.

Key signs? You’ll feel a dull ache or sharp pain on the outside of your elbow. The area’s usually tender to the touch, especially when you press on the muscles or the bone. Climbing (especially those tiny crimps, slopers, and compression moves), lifting heavy stuff, holding frying pans, and repetitive gripping only make it worse. You might even notice it sticking around all day.

Why does it happen?

Repetitively over-stressing the tissues of your medial elbow causes structural changes to the tendon. The collagen fibers become disorganized, sometimes swollen or enlarged, weak, and painful. Think of an old climbing rope that is frayed and clapped out. The fibers are more disorganized and weaker than a fresh rope.

That’s how it all kicked off.

Then, because it didn’t get properly treated (thanks to some sketchy PT advice or self-diagnosis), those tendon changes just kept hanging around.

“But I’ve backed off on climbing and the pain’s still there!” Well, here’s the thing—tendinopathy won’t heal unless the tendon gets a specific amount of load, at just the right frequency, and for long enough.

“Alright, what’s the game plan for loading this elbow tendon?”

The best research says medial epicondylalgia responds to a combo of manual therapy and progressive loading exercises. Manual therapy could involve joint mobilizations, soft tissue work, or dry needling. Exercise therapy? That’s where the magic happens. You’ll follow a progressive loading program targeting the affected muscle/tendon combo, plus stabilization drills for your wrist and shoulder. This progressive loading is essential for regenerating the tissue and getting long-term healing. You’ll likely start with lighter exercises and work up to tougher loads, rebuilding that tendon structure and waving goodbye to that climbing-induced elbow pain.

If you’re battling elbow pain, reach out to the pros at Rock Rehab to schedule an appointment in Santa Fe, New Mexico. They’ll set you up with a dialed-in diagnosis and an evidence-based game plan that’s custom-made for rock climbers.