Climber’s Elbow: Why It Happens and How to Fix It

The Early Signs

So you’ve started noticing your elbow.

At first it’s just a whisper — a little soreness or stiffness on the inside or outside of the elbow. It might feel tight in the morning, but it eases once you warm up and start climbing.

Then it grows louder.

You feel a sting or quick “ping” of pain on certain holds. Gripping something the wrong hurts. Maybe picking up a bag of groceries reminds you it’s there.

Eventually, for some climbers, it crescendos into something much louder — a sharper pain that limits pulling, opening a jar, carrying a bag, or even sleeping comfortably.

Most climbers call this “climber’s elbow.”

Before climbing became popular, it was called:

• Tennis elbow → outside of the elbow

• Golfer’s elbow → inside of the elbow

These names describe where the pain is located, not what’s actually happening.

• Outside → common extensor tendon

• Inside → common flexor tendon

Despite the different names, the underlying problem is usually the same:

Tendon overload causing tendon break-down and even cell degeneration

The key to fixing it lies in understanding what’s happening inside the tendon.

Why you get Climber’s Elbow

The muscles that flex and extend your fingers and wrist run along the forearm and attach near the bony bumps of the elbow.

Every time you:

• grip

• squeeze

• pull

• lock off

you are loading these tendons.

That’s why elbow and forearm pain account for roughly 15–20% of climbing injuries, making it one of the most common overuse issues after fingers and shoulders.

You’re not alone.

During hard climbing, forces through the finger flexors can exceed 3–4× body weight, placing significant stress on the elbow tendons (Schweizer, 2001; 2012).

Left: inside of elbow/Right: outside of elbow

Lateral Elbow Pain (Outside of the Elbow)

The lateral epicondyle is the bony bump on the outside of your elbow where the wrist and finger extensor tendons attach.

These include:

• Extensor carpi radialis brevis (ECRB) (most commonly involved)

• Extensor digitorum

• Extensor carpi ulnaris

• Extensor digiti minimi

When you grip these muscle fire to stablize sthe wrist. Grip strength improves when the wrist is held in slight extension.

You’ve probably felt this — as you fatigue, instinctively your wrist cocks to wrist to maintain grip. So wrist extension during gripping is quite common and adds strain to the outside of the elbow.

Why the ECRB Gets Injured

The ECRB is the primary tendon involved in lateral elbow pain for several reasons:

• It sits deep under another muscle (ECRL) and gets compressed

• It experiences high load during gripping as it stabilizes the wrist

• It has relatively poor blood supply

• It can be mechanically compressed between the radial head and humerus

Functionally, even though gripping uses your flexor muscles:

Your finger flexors try to bend your wrist forward, and the ECRB must contract to hold the wrist in extension.

That constant isometric stabilizing load is why this tendon commonly becomes overloaded.

Medial Elbow Pain (Inside of the Elbow)

Even more common in climbers is pain on the inside of the elbow.

Five muscles share a common attachment here via the common flexor tendon:

• Pronator teres

• Flexor carpi radialis

• Palmaris longus

• Flexor carpi ulnaris

• Flexor digitorum superficialis

Together, they form the flexor–pronator mass, responsible for gripping and finger flexion.

It’s no surprise this tendon gets irritated with climbing.

What Might Surprise You

The most commonly involved muscle in medial elbow pain is:

Pronator teres

Why?

Climbing creates a unique biomechanical demand:

• You grip → requires pronation

• You pull → activates biceps (which supinates)

This creates a force conflict.

Biceps = supination → Grip position = pronation  Pronator teres → works hard to resist the biceps pulling the wrist in the opposite direction 

So the pronator teres is constantly working to counteract the biceps during pulling movements.

At the same time:

• finger flexors

• wrist stabilizers

• pronators

are all transmitting force through the same tendon attachment.

This repeated loading leads to tendon disorganization and pain.

Lock-Offs and Elbow Load

Climbing is a lot of sustained isometric elbow flexion, especially during lock-offs.

This recruits:

• Biceps

• Brachialis

• Brachioradialis

These larger muscles increase:

• compressive forces

• shear forces

across the elbow joint.

At the same time, the pronator teres is resisting supination.

The result:

Increased stress on the flexor–pronator tendon at the medial elbow

The Big Picture

Climber’s elbow is not caused by one single issue.

It’s the result of:

• high grip forces

• sustained isometric loading

• competing rotational forces (pronation vs supination)

• and repeated stress through shared tendon attachments

Over time, this exceeds the tendon’s ability to tolerate load.

Tendinitis vs Tendinosis (Why Ice and Rest Often Fail)

When your elbow starts hurting, it’s easy to assume it’s inflamed.

After all, “-itis” means inflammation.

And in true inflammatory injuries—like an ankle sprain—rest and ice make sense. The area is swollen with clear inflammation and needs time to do some healing and resove inflammation before heavy loading.

But most elbow pain in climbers isn’t tendinitis.

It’s tendinosis.

What’s Actually Happening in the Tendon

Left side shows healthy tendon vs Right side tendinopathy

• Collagen fibers become disorganized, reducing their ability to handle load

• The tendon becomes thicker, but weaker

• Small blood vessels and sensory nerves grow into the tendon, increasing pain

• There is an increase in fluid, which adds bulk but reduces efficiency

• Some tendon cells die, and new collagen is often Type III collagen, which is weaker and less tolerant to stress then the needed Type I collagen.

Instead of a strong, rope-like structure, the tendon becomes more like a frayed climbing rope. It can still hold weight—but not well, and not repeatedly. Possibly, if ignored like a core shot rope, the tendon has micro tears in tears tissue and significant inability to withstand load.

Why Rest, massage, and Ice Do not Fix It

Rest can reduce symptoms temporarily.

But it does not restore tendon structure or load capacity.

So you rest for a week, a month, even three months and then

you return to climbing…

…and the pain comes back.

Because nothing has changed in the tendon’s ability to handle load.

What Actually Improves Tendon Health

Tendons don’t heal by resting.They remodel in response to load.

When you load a tendon properly:

• Collagen production increases

• Collagen fibers realign and organize

• Tendon stiffness (ability to resist deformation under load) and strength improve

• Growth factors are released that support tissue repair

Much like muscle, the tendon adapts to the demands placed on it.

Types of Loading (and What We Know)

Types of muscle contractions

There are different ways to load a tendon:

• Isometric – muscle contracts without changing length

• Concentric – muscle shortens

• Eccentric – muscle lengthens under tension

Most tendon research has been done on the Achilles and patellar tendons, and far fewer on elbow but we do know that for the elbow

• All contraction types can stimulate tendon adaptation

• Isometrics may help reduce pain in the short term

• Eccentric and slow loading may better target dysfunctional tendon regions

One important concept is stress shielding which is common in achilles but also show to occur in elbows.

Part of the tendon becomes weak, and the healthier tissue around it absorbs most of the load.

Slower, controlled loading (especially eccentrics) helps drive force into those underloaded regions, which is necessary for remodeling.

How I Think About It Clinically

The “best” loading strategy depends on the person.

• Chronic, sensitive tendon → start with mid-range isometrics

• Stronger, less irritable tendon → progress to heavier loading, including lengthened positions of the tendon

From there, the key is progressive overload while managing total climbing volume.

Dosage Matters More Than You Think

Tendon adaptation is not just about what you do—but how much and when.

Collagen production is triggered by a signal from loading.

Once that signal is sent:

• Repeating it immediately does not make it stronger

• The tendon needs ~4–6 hours before it can respond again

A simple framework:

• ~3-4 working sets (enough to stimulate the tendon)

• ~8–12 reps or a sustained hold

• Repeat 2x/day if not climbing

• If climbing, separate rehab from climbing by 4–6 hours

More is not better.Better timing is better.

The Mistake Climbers Make

Most climbers fall into one of two traps:

• Stop climbing completely

• Climb through pain

Neither approach loads the tendon properly.

Instead:

• Modify climbing so it stays below your pain threshold

• Add targeted tendon loading

• Progress gradually

• hang-boarding is not exactly resting from climbing- consider that part of your climbing volume and load and that too be under your threshold for causing pain

• Any form of gripping will contract the wrist flexors and extensors. Gripping dumbells and bars may bother your elbow. Use the pulley stack at your gym with a wrist cuff to turely rest the elbow tendons.

Also remember:

Tendons adapt much slower than muscles.

This is why elbow pain often shows up after a training cycle that got stronger.

The Timeline Most People Underestimate

Tendon rehab takes time.

Most studies show the best results:

• Minimum ~12 weeks for meaningful change

This isn’t a quick fix—it’s a rebuild.

Don’t Ignore the Basics

You cannot out-train poor recovery.

If you’re not progressing, look at:

• Sleep

• Nutrition

• Stress

If those are off, your tendon’s ability to heal is limited—no matter how good your program.

Key Takeaways

• Tendon pain is rarely inflammation

• Rest alone does not fix the problem

• Tendons need progressive load to remodel

• Loading type matters consistent, timing, appropriate stimulus

• Tendons adapt slowly—patience is required

• Sleep, nutrition, and stress management directly impact recovery