A revolutionary new drug can relieve tendinitis. But the cure is in your mind.
photo caption: Tendinitis sufferer Mike Landkroon easing back into it after losing five years of climbing.
A friend once described Zen to me as "when your pants fit just right." He said when they're too tight they cut in, they're uncomfortable, and on your mind. When they're too loose you're always hauling them back up, and they're on your mind. When they fit just right you don't think about them, your mind is free for other thoughts, and you have the "Zen of trousers."
I have suffered from tendinitis in both my elbows for five years. This has kept me off the rock, and has constantly been on my mind. Now, thanks in part to Celebrex, a new anti-inflammatory drug, I believe I have found a way to regain the "Zen of elbows."
When I started climbing I was a muscle-bound linebacker type. I climbed like Sylvester Stallone in Cliffhanger, using brute force to haul myself up the rock. Despite my thrashing, I enjoyed the sport so much that I decided to become a "real climber," and quickly. I went from a fitness routine that consisted of three or four days a week of pumping iron, combined with three or four nights of pumping Coors, to cragging every weekend and working out in the climbing gym three or four evenings a week. I dieted to lose weight, put a chinning bar in my office, and even walked around with a forearm exerciser. The result was inevitable: overuse injuries. Within a couple of years my elbows were sore just to touch.
At first I tried to combat the pain using traditional anti-inflammatory drugs, like aspirin and ibuprofen. When these didn't work I moved on to stronger prescription versions: Anaprox, Naproxen, and Voltaren. The drugs I used upset my stomach, and even the strongest didn't significantly reduce my pain. Nevertheless, I was too obsessed to ease up on climbing. I kept cragging and training like a maniac.
After about six months of taking pills, I progressed to cortisone shots. My doctor cautioned me to take it easy, saying that the shots would initially weaken my tendons, so I took a month off before returning to my old habits. My elbows felt great for six months. Then the effects of the cortisone wore off and the pain was worse than ever. I'd caused further damage by climbing hard while the shots masked the injury. Now it hurt so much that opening doors and leaning on counters were my new crux moves.
My doctor had nothing else to offer, so I sought alternative therapies. I tried ultra-sonic therapy, laser therapy, pulsed magnetic therapy, chiropractors, forearm massage, calcium and magnesium supplements, a gluten-free diet, homeopathy, and vegetarianism, to name a few. At one point I was told that the sutures between the plates in my skull were not moving properly and endured several weeks of "cranial suture manipulation." All I got was my scalp buffed to a nice sheen. I walked around for a few weeks with "special" magnets taped to my elbows; they were supposed to increase circulation and promote healing. My bank card stopped working and now I have some extra fridge magnets. I took a break from treatments and maintained a positive attitude by devoting myself to useful tasks. Now I can program my VCR and will never again be plagued by the dreadful flashing "12:00."
None of the treatments cured me, some helped, but most didn't. The most effective for me was high-intensity, deep-friction massage. This became an undeclared battle between myself and a rather sadistic physiotherapist: me to remain still in the chair without screaming; him to have me writhe in pain before his fingers gave out. When I combined this torture with stretching and mild exercise it was somewhat effective. I couldn't climb, but at least I could open doors and lean on counters without wincing.
My turn-around began last year, when I came across an article in the New Yorker about Celebrex, which was then undergoing clinical trials in the United States. The more I read about the drug, the more I thought it might help my tendinitis.
Celebrex is the first of a new class of designer anti-inflammatory drugs to reach the market. Traditional anti-inflammatories, like the ones I had been taking, act like a carpet-bombing campaign; they are somewhat effective in taking out inflammation but also cause collateral damage. Celebrex is like a smart bomb, hitting only inflammation. Here's how it works:
When you experience some kind of physical trauma such as a tendon injury, your body produces high levels of hormones known as prostaglandins. Prostaglandins are responsible for inflammation, swelling, redness, and pain at the site of the trauma.
To make prostaglandins, your body uses cyclo-oxygenase or COX enzymes. Traditional anti-inflammatories work by suppressing the COX enzymes and thus the production of prostaglandins. The problem is that your body also uses small levels of prostaglandins for essential tasks such as the production of blood platelets, proper kidney function, and protection of your stomach lining. Traditional anti-inflammatories affect these "housekeeping" prostaglandins as well as the elevated levels of prostaglandins produced by trauma. This is why the pills I popped caused stomach aches, reminiscent of my Coors curling days. Other possible side effects of these drugs include impaired blood clotting (a problem if you are injured), stomach ulcers, and kidney failure.
Recently, however, scientists discovered that there are two COX enzymes, COX-1 and COX-2. COX-1 is responsible for housekeeping functions, producing prostaglandins at a pace similar to my aunt driving her hatchback to the newsstand. COX-2 is used only in the event of a trauma, cranking up prostaglandin production like a supercharged hot rodder, pedal to the floor, in full-blown road rage.
Once scientists recognized the difference between COX-1 and COX-2 they started looking for a way to shut down COX-2 without affecting the COX-1. Well, all praise science, as this is exactly what Celebrex does. It is the smart bomb that inhibits prostoglandin production at the site of a trauma, such as a tendon tear, but doesn't cause collateral damage to your blood, kidneys, or stomach.
Celebrex is now approved in the U.S. and my home, Canada, although it is available in both countries by prescription only. I have been taking the drug for several months and am cautiously optimistic. My elbow pain is mostly gone and I haven't noticed any side effects. I have also been able to start climbing again, although I still get some pain if I do too much, which tells me my underlying condition is still there. Now I listen to my body very closely and back off when I should.
My background reading led me to believe that the primary advantage of Celebrex is a lack of side effects. But I have also found it more effective than the older drugs I was taking in reducing pain and inflammation (Note: Medical studies do not support this observation, see "Treating tendinitis" sidebar.)
Although I think Celebrex has helped me get back on the rock, it is important to note that it is new to the market, has not been tested on tendinitis (the clinical studies involved arthritis sufferers), and may still have unforeseen drawbacks. It is also only part of my cure. Moderation is key. I don't know how many stories I've heard about people overdoing it and ending up sick or injured. I thought I was made of stronger stuff and that it could never happen to me. Well it did. I was in such a rush to get better that I lost five years of climbing.
Through all of my adventures in traditional and alternative therapies I have also learned that no doctor or therapist knows all the treatment options. It is up to you to be proactive. While waiting to talk to my doctor about Celebrex for the first time, I leafed through a Time magazine article about the drug in his waiting room, even though he knew nothing about it.
In the last couple of months I've done some low-grade climbs and loved them. A few years ago I would have been down on myself for not being good enough to do harder climbs. Now I'm just happy to be out there. Being able to climb next week and next year is more important to me than sending today's hard-ass problem. On a few occasions I've pulled into my local rock gym's parking lot, but turned around with no regrets because I felt my body needed a break.
My elbows are still on my mind, so I have yet to reach the Zen of elbows. But I do believe I have reached the "Zen of self-control."
Elbow problems first made Mike Landkroon ditch his rock shoes for a camera at the crag. Now a well-known climbing photographer, he faces the opposite dilemma: Climbing is cutting into his photography time.
Many climbers suffer from tendinitis or tendinosis of the medial elbow - a.k.a. golfer's or climber's elbow. This is an acute (days-months) or chronic (months-years) injury of the tendons that help flex the fingers and wrist. The injury is located at the bony point on the inside of the elbow where the tendon anchors to the forearm's flexor muscles.
... [I was unable to OCR this sidebar; I may type more of it later if there is interest] Here is an outline:
definitions of tendinitis and tendinosis
The use and abuse of anti-inflammatories (dosage levels, etc.)
Celebrex (Celebcoxib)
Other treatments
Surgery
For stretches and exercises that can help prevent tendinitis see the Sport Climbing Tech tip "Balancing Acts" in Climbing No. 192.