Like most climbers, when I first started I dove right in the deep end. I would climb every day for as long as I could. Of course, this quickly lead to injury. I developed fairly severe pain on the inside of my elbow, which I assumed was tendinitis. I even went to the doctor (more than one) and they confirmed my suspicion. They told me to rest, do exercises, etc. but it never went away. It wasn’t until maybe 5 years later that I went to a good physical therapist who actually found the real issue. This experience, and a few others, has drastically decreased my faith in M.D.’s for treating injuries, but that’s a rant I won’t get in to here.
For those five years when I went to the doctor, I would point to my elbow, just about the bone and say “it hurts right here,” and the doctor would say, “that’s weird, it’s probably medial epicondylitis (golfer’s elbow), but that’s usually painful below the bone. Go to physical therapy for golfer’s elbow.” Finally I went to a doctor that just said, “I have no idea. Let’s make you pay for an MRI, get nothing out of it and have the P.T. figure it out.” So instead of having the P.T. just follow orders, this time he diagnosed me. As soon as I pointed to my elbow above the joint he said it was ulnar nerve entrapment, and he fixed it in one session.
There are three major nerves that run from your neck all the way to your fingers: ulnar, median, and radial. The ulnar nerve runs along the inside of your arm and ends in your pinky and ring fingers.
If you’ve ever hit your “funny bone,” or you’re pinky and ring finger fell asleep while leaning on your elbow, that’s the ulnar nerve.
So what is entrapment? Well, it’s exactly what it sounds like. The nerve gets trapped at a location then when you move your arm the very taught nerve gets yanked and causes pain. What’s tricky about a nerve issue, is it generally causes referred pain, meaning the site of the issue can cause pain in another area. So with the ulnar nerve, a very common symptom is tingling in the fingers, even though the compression is occurring in say the elbow. However, tingling is not THE symptom; I never had tingling which is why I went undiagnosed for so long. Also since the nerve is so long, there’s many possible sites for it to be compressed. In my case, I was having pain in my elbow, but the compression was happening in my shoulder.
The culprit was pectoralis minor. You can see in the picture above that all three major nerves combine together in the neck and the pec minor (cut away in picture) runs over the bundle. The pec was super tight and squeezing on the nerve. If you have climber’s hunch you probably have tight pecs and you probably are susceptible to entrapment at this location. Can you guess what the best fix is? The fix that probably would fix about 80% of all neck, back, and arm issues?? Posture! Sorry folks, your parents and cranky old middle school teachers were right. Sitting up straight is good for you. What really drove this point home for me was something I heard Dr. Jared Vagy, aka The Climbing Doctor said. A lot of climbers (myself included) think “oh I got some shoulder pain from climbing,” but what percentage of the week are you actually climbing? Maybe 10%? And what percentage are you hunching over a desk or a work bench or sleeping on your stomach with your neck wrenched to one side? Yeah, that’s what’s probably causing your pain and what needs to be fixed. “But Nerd, sitting up straight isn’t comfortable!” I know I agree and I struggle with posture all the time, which is why I’ll go through some more specific things you can do to help with ulnar nerve entrapment.
Ok let’s think about what’s happening. The pec is tight and grabbing the nerve, causing it to get stuck and pull at the elbow. So how do we fix this? Well first let’s loosen up the pec. Stretch it out you say? Not yet. A massage therapist once told me that you can think of knots kind of like actual knots in a rope. If you have a loose knot in a rope and you stretch the rope, all you’ll end up doing is tightening the knot. So before we stretch the pec, let’s loosen up the knots. Here’s a video of how to work the pecs with the trusty lacrosse ball. Also, if you’re not familiar with Kelly Starrett, check out his channel. He has mobility exercises for just about anything.
Ok, now that the tight spots are worked out we can stretch the pec. For me, doing a normal pec stretch will actually pull more on my ulnar nerve so I prefer to do a light, but longer (1 min) stretch on the foam roller:
More of a relax the muscles instead of stretching them. The final step is to address the nerve itself. What we want to do is get the nerve running properly through it’s tunnels and channels. To do so, you have to floss! Yet more things your parents told you to do as a kid ;). “Flossing” the nerve after the major tension is released will further loosen up any other sticking points. So like I said before the nerve anchors in the neck and fingers. The goal is to first pull the nerve towards the fingers then back towards the neck so you’re literally flossing it through the rest of your arm. Here’s a video demonstration.
I’ll usually do about 20 reps and my elbow pain will be gone immediately. One note while doing these: nerves don’t really stretch. So if you’re feeling a lot of tension in the nerve while doing this, you’re not really getting the full benefit.
This protocol has worked wonders for me and hopefully if you have elbow pain that is persistent and treating for golfer’s elbow isn’t working, looking at the ulnar nerve will help!