Date: January 6th, 2017

Esther created two videos to help you treat Tennis Elbow and Golfer’s Elbow (common climber ailments described in the interview) that are each an hour long. You have to pay for these videos, but it’s well worth the investment if you struggle with elbow pain.

Esther Smith Links

• My first interview with Esther about shoulders
• Esther’s website: www.grassrootsphysicaltherapy.com
• Esther’s new website with resources for injuries: www.selftreatment.com
• Esther’s article on how to Hang Just Right
• Esther’s article specifically about elbows: Hang Right: Part 2
• Free videos about treating elbow pain (link no longer available)

Training Programs for You

• Check out our Route Climbing Training Program
• Check out our Bouldering Training Program
• Our other training programs: Training Programs Page

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Transcript

Neely Quinn: Welcome to the Training Beta Podcast, where I talk with climbers and trainers about how we can get a little better at our favorite sport. I’m your host, Neely Quinn, and this is my first episode of 2017. I really hope you had a good holiday season, and maybe went somewhere climbing. I did not- I sprained my finger bowling at a Christmas party, so I haven’t climbed in a couple of weeks now.

A lot has been going on with me, besides my finger injury. I also just finished a puzzle! I have been thinking about getting surgery on my other shoulder. I went to my surgeon, and I talked to him about the MRI that I got on my non-surgical shoulder, because I’ve been having pain in there for a couple of years. It turns out I have a couple of tears in my labrum, and a bone spur, just lie I had in my other shoulder basically. He said I could have surgery, but I decided that I’m not going to jump into that just yet. I’m going to actually see Esther Smith, the physical therapist, for my shoulder, for a couple of months and see if I can make a dent in it with really diligent physical therapy before I have surgery again, because surgery sucks.

So speaking of Esther, she is my guest today. Esther was on the show about a month ago, and we talked about shoulders on that episode. That’s when I decided that I really wanted her to be my physical therapist. Today we are going to be talking about elbows. We had this conversation and she did a really good job of summing up what the most common shoulder- sorry- elbow injuries are, and how to treat them. She also made some videos just for you guys- just for this interview. If you go to TrainingBeta and go to the podcast page and find this interview, in the notes you’ll find a few free videos where she explains a lot of the things that she talks about in this interview. It’s just really hard to describe them well so she made some videos.

She also created a website called selftreatment.com. She has some free videos on there, but she is also selling some tutorials for how to treat some different ailments. She has two on there- one for golfer’s elbow and one for tennis elbow. I think if you have been struggling with those things, maybe it’s worth your time and fifteen dollars to check those out and get the information that you need without seeing a bunch of physical therapists and body workers- it might just do the trick for you.

She is going to explain a lot in this interview about what to do for golfer’s elbow and tennis elbow, what those are, and why they’re called those things, and why climbers get them. Hopefully this interview will help you if you have elbow issues, and then our next interview is going to be about fingers, so stay tuned for that in about a month. I guess that’s it- here’s Esther Smith. Enjoy.

Neely Quinn: Alright, welcome back to the show Esther, thanks for being with me again!

Esther Smith: Thanks for having me again Neely!

Neely Quinn: You did an episode with me a few weeks back on shoulders. Today we are going to focus on elbows, and then we will do another one on fingers. For everyone who didn’t listen to the shoulder one, can you tell us a little bit about who you are?

Esther Smith: I’m a doctor of physical therapy, and I own Grassroots Physical Therapy in Salt Lake City, Utah. That is a private physical therapy practice, and I treat mostly climbers. I’ve been practicing for almost six years, and have treated hundreds of climbers in that time, and over a dozen pros, and I climb myself extensively. I have a couple of physical therapists that work with me as well- Katy Scott and Katey Blumenthal. They’re also climbers and treat climbers, so we’ve got a cool little operation going here.

Neely Quinn: That’s pretty awesome that you guys focus on climbers, that’s very rare.

Esther Smith: We have fun doing it.

Neely Quinn: Cool. Like I said before, I might come out and see you for my other shoulder, which would be fun.

Esther Smith: That would be excellent.

Neely Quinn: Before we jump into elbows, after our shoulder conversation, we had talked about the questions that you got from some people. One of the main ones that I wanted to touch on before we jump into elbows is somebody- I think a few people- asked you “Why do I feel more fatigued when I ‘hang right’ on the hangboard?’”. Can you touch a little more on that?

Esther Smith: Yeah- so that was stemming out of our talk, but also from the article that I wrote for Black Diamond on optimal hanging position in general. When people were hanging right, they felt more fatigued overall and felt like they couldn’t last as long on the hangboard, and they were kind of discouraged by that. I said that that’s actually a good thing. When we are hanging on a hangboard, our intention should be to simulate our climbing environment, and in our climbing environment, we are fully engaged. We should kind of have that intention, and maybe even a little visualization while we are on the hangboard, that we are actually caring about how we hang and the effort in the recruitment we get when we are hanging right.

What was kind of detailed in that article and what we talked about is that it’s really important that you engage your whole shoulder girdle, that you engage your core, and that you kind of create this really tight body position. When we are deadhanging, we should kind of consider that we are recruiting all the right muscles, that we are in really good alignment, and that we are simulating how we want our body to feel when we are actually engaged on the wall. So to not be discouraged by that but actually look for that when we are deadhanging- that kind of full engagement and optimal positioning.

I think that goes to this talk really well, that with an appropriately engaged shoulder complex, that helps to engage our elbows in the most ideal position as well. We should feel a lot of effort coming from our shoulders and our core to protect our elbows when we are deadhanging, especially when we are max deadhanging or hanging with more weight than bodyweight, which a lot of people are doing these days.

I just wanted to kind of send that message out, that we should be really having a lot of intention on the hangboard, we should be super focused on our form and alignment, we should feel super engaged, and that’s why we break our hangs into sets and reps. A lot of times, if you look at a lot of the training beta out there, we should be resting two to three minutes between hangs. That means we are actually putting our pretty max effort, and then we are resting a good solid bit in-between.

Neely Quinn: If somebody had been doing a hangboard routine for a while and they had been doing it the “wrong way”, sort of hanging on their bones so they weren’t very engaged, and then all of sudden they hear your podcast episode and they’re all “I’m doing this wrong, I need to engage my shoulders, pull them down, pull my shoulder blades back”, and then they start to feel fatigued and they can’t get through their workout. Did you hear of anyone that that happened to, and if so what should they do?

Esther Smith: I did hear about that, and it’s not a bad thing. It just means that you need to adapt to the new scenario, and the new scenario is that you’re recruiting a lot of musculature, and you’re actually putting out a lot more effort. You might just have to dial back. If you were adding weight, loading beyond body weight, and now hanging right at that same weight feels too much and you can’t be on there for ten seconds, then you need to back down the weight. Or, if you’re just at bodyweight, then you need to take some weight off of yourself. Ultimately you want to be hanging in the most optimal position, having that recruitment, and then kind of progress into more time, or a harder workout.

What we should be seeing is that, depending on what you’re doing, if it’s repeaters, or max ten second hangs, that we are getting fatigued to a level where we do need to rest in between and we can’t just hang on there forever. That’s not why we are training. If you really want to be specific about how you’re training these different systems, then you want to train in these kind of appropriate time frames with appropriate sets and rests.

Neely Quinn: So when we were talking about hanging right last time, we talked a lot about shoulders. But how does this apply to elbows?

Esther Smith: That’s a great question, and I’ve gotten a handful of questions on that. There seems to be a little bit of debate going, and there seems to be two camps. One camp suggests that we should be hanging with straight arms but an unlocked elbow. To the naked eye, the arm appears to be pretty straight. Then there is another camp that suggests that we should be deadhanging with a visually bent elbow. It’s my opinion, among the opinions of others including Eva Lopez and Jared Vagy who I was able to touch base with, and all of us agree that it’s much safe for the elbow to be loaded in its longitudinal kind of long axis position.  If we end up bending our elbows too much, we put a ton on strain on our primary elbow flexors. Those muscles aren’t meant to be held in those positions, and it can lead to injury, like tendinitis type situations at the elbow itself, nerve entrapment at the elbow, and then upstream, by bending the elbows, it can affect our shoulders negatively by encouraging internal rotation of the shoulders.

So what we’re all saying is that we should start our hang with a really good solid core and shoulder girdle position. Our upper arm bones should be trying to externally rotate or be held in neutral. Our elbow then will rotate into pronation to hold the hold that we are on, and our elbows should stay in a very slightly unlocked position, but you shouldn’t see a big visual bend on it. That loads the upper extremities, we think, better according to its design. If we’re doing max deadhanging or putting weight on ourselves, that in the end is going to be much more beneficial and will prevent some of those soft tissue injuries that we see commingle when people engage in training routines.

Neely Quinn: Okay, I’m going to back up for a second. I think that there are some people, like me, that don’t know what the words pronation and external rotation means. Could you give us some visual cues of which way our elbow should be pointing, which way our other body parts should be pointing?

Esther Smith: Sure. One thing that we all be doing, hopefully for this talk, is providing you guys with a video demonstration on optimal hanging. That’s going to be really nice. But I will try to verbally explain it the best I can right now. The landmark that I like to use the most in terms of what our elbows are doing is the elbow crease- so the line where our elbow hinges and folds. When you’re hanging, that elbow crease, if you make an “X” right and the center of that crease, that “X” should be rotating towards your face.

Neely Quinn: Okay…

Esther Smith: So you should be able to see your own creases- they shouldn’t be diving inward and rotating away. They want to be rotate outward and towards you- that’s external rotation of our upper arm. What’s tricky for climbers is to maintain that- maintain the elbow crease rotated towards your face. Then pronation is the ability for your lower arm, or your forearm, to go palm down. So that’s you gripping a hold, right? It wouldn’t be palm up. So on a hangboard you’re palm down, and you’re crimping or using a sloper or whatever. What happens is when we pronate or we go palm down, usually that has a tendency to drag the upper arm in with it, so your elbow crease would start to dive inward. The tricky part for the elbow is to maintain the humerus, the upper arm bone, neutral to the shoulder, and then be able to disassociate that motion and rotate your forearm separately without the whole thing collapsing inward.

What we see is that people end up being their elbows quite dramatically to compensate for weakness. It can be a weakness of the fingers, a weakness of the elbow, but more commonly I think it’s a weakness and level of tension at the shoulders that leads to this compensation where we have to bend our elbows and chicken wing to stay hanging. What Eva Lopez and Jared Vagy and myself all agree on, is that the chicken winging and that compensation leads to a tendency to have shoulder issues, like impingements, issues at the shoulder. Then at the elbow, more of the tendinitis development that we see. Then out at the fingers some of those issues if we are compensating from our elbows on our shoulders, then our fingers actually aren’t being strengthened according to how we want them to be strengthened, which is part of the reason that we are hangboarding in the first place.

Neely Quinn: So a lot of people chicken wing. I mean that can happen when we’re fatigued, or it can happen when we are just beginning as climbers, or it can happen when we are on something that’s too hard. What can you suggest to avoid that?

Esther Smith: I think that goes to why we are even on the hangboard in the first place. We should be training ourselves to get strong enough so that we don’t chicken wing. Even if you are a brand new climber and you want to hangboard like everybody else is hangboardining, it’s my opinion that you should be hangboarding to facilitate the best form, optimal recruitment and engagement. Don’t worry about maxing out or anything- just hang to hang right. Hang for form. That way when you go out on the rock, you’re much more likely to replicate that behavior and that pattern, and you’re probably less likely to get injured that way, right?

If you’re a more experienced climber and you’re loading yourself up, or you’re doing these crazy hangboard or even campus workouts, we don’t really want to be facilitating those poor habits and chicken winging while training. We need to dial in our parameters of our exercise according, so we aren’t reaching that state of fatigue and then compensating and then having poor movement and potential for injury develop as a result.

Neely Quinn: So if you find yourself chicken winging on a route, maybe just let go?

Esther Smith: I mean on a route it’s going to happen, but that’s a small instance probably. You wouldn’t want to be chicken winging all the time- it might mean that you need to go back and train or work on some different sequence or whatever. But yeah, I mean if it’s happening occasionally and you’re trying hard and you’re all out, that’s not a problem. It’s when it’s happening all the time- that repetitive misuse- that’s what we want to stay away from.

Neely Quinn: Okay, that’s a really good distinction.

Esther Smith: Yeah, so when somebody has that tendency, well then maybe they need to look at why that’s occurring and what they could strengthen so that doesn’t happen all the time. Honestly, for a lot of climbing and resting and hanging, we should be able to do that in a more optimal alignment so we are moving from a stronger foundation. The chicken wing is not necessarily a strong foundation for any part of our upper extremity.

Neely Quinn: We talked about this when I interviewed Jared Vagy. We talked about elbows too. He said that sometimes he’ll watch people climb that have elbow issues and they are chicken winging, or their elbows are out, or their wrists are misaligned. And they do it all the time when they’re climbing. It seems like even just having somebody- a friend- watch you climb and observe, could that be helpful with chronic injuries?

Esther Smith: Yeah, that’s totally helpful. I go to the gym and I watch clients climb, and I try to pick out those movement patterns and those compensatory patterns, and I think it’s super helpful to be called out on that. It’s maybe something you’ve done for a long time and you have no idea. To have somebody to observe you would be great, and then taking that information and then using it as something to train, so that we aren’t just training arbitrarily, but we are training our weaknesses and really specifically for those areas that need it, and training our movement patterns. I think thats what I wanted to detail with hangboarding, that we are doing it with a lot of intention.

Neely Quinn: Yeah. Okay. So in general, with elbows. A lot of climbers have elbow issues. Can you talk about what the most common elbow issues are that you see?

Esther Smith: Yeah, absolutely. By far the most common is going to be tendinitis or tendinosis in the form of golfer’s elbow or tennis elbow. There are some other muscles that can commonly develop tendinitis or tendinosis at the elbow, but it’s the golfer’s elbow or tennis elbow- and we can talk about more in detail what that means- those are the most common. You can get it from the chicken wing thing or hanging with bent elbows, your brachioradialis, or your brachialis, are two other common muscles to develop the tendinitis type syndrome.

I think that moving forward in the discussion, we should really detail those two- the golfer’s and tennis elbow. Those are by far the most common. The other thing is, going back to our shoulder talk, that idea of a joint derangement, if you remember that. It’s kind of that malalinged or offtrack joint positioning. In the elbow, that’s actually quite common. Climbers don’t really recognize it, because it’s not frequent that you think that your elbow joint actually has a problem. Most people thing that if they have elbow pain, it’s a tendinitis or tendinosis. What I’ve found actually, is that a lot of that type of presentation is actually caused by a joint issue. I was going to probably detail a client example of that so you guys are clear on what that looks like and how it’s different from a tendinitis.

Then the third one, probably, is the fact that elbow pain can be caused by a referred pain from your neck. I see a lot of climbers who have neck issues, but they feel the pain at the elbow, and they also think that that is tendinitis. The important thing with all of those distinctions is that they are treated very differently. I think that elbow issues among climbers are not treated that well most of the time. That’s why they become so chronic and mismanaged, and it takes people out of climbing just as much as shoulder issues do, if not more. They’re pretty insidious and aggressive, these chronic tendinopathies. I really want to highlight more ideal treatment strategies so people can start to understand how to best support themselves if they’ve got this going on.

Neely Quinn: Fantastic, this sounds like a great talk. Let’s start wth golfer’s and tennis elbow.

Esther Smith: Okay- so with golfer’s and tennis elbow, we are talking about either an acute issue, which we call a tendinitis, or more of a chronic issue which we call tendinosis.

Neely Quinn: That’s the only difference?

Esther Smith: Sorry- golfer’s and tennis elbow refer to different parts of the elbow that are injured. Golfer’s elbow affects the inner elbow, or the medial elbow- that little bony prominence on the inside. Tennis elbow affects the outer aspect of the elbow- the bony prominence that is on the outside of the elbow. Tennis elbow affects the extensor muscles of the wrist and fingers, and with golfer’s elbow, that affects the flexor muscles of the wrist and fingers.

Neely Quinn: So in layman’s terms, it seems like tennis elbow is affecting the tendons and muscles that you use to put your hands and wrists upward, and the other one is affecting the tendons and muscles that you use to put it downwards?

Esther Smith: The muscles and tendons downward would be your flexors- your crimpers, grippers. The extensor muscles are the ones that pull your fingers away, open them, and straighten them.

Neely Quinn: Right, okay.

Esther Smith: When we refer to it as a tendinitis or a tendinosis, that’s a time frame thing. When we talk about tennis or golfer’s, that’s a different part of the body.

Neely Quinn: Okay.

Esther Smith: So what’s important about that is golfer’s elbow, the ones that affect the flexors, the crimpers, grippers, the one that closes our hand, that type of problem is connected to a muscle fascial system that is different that then other one. So in the case of golfer’s elbow, those finger flexors and that inner bony prominence of the elbow, that’s really connected via this myofascial system to your biceps muscle, to your pec major and minor, and to your latissimus dorsi, your lat. What’s important about that, is that those muscles happen to be our very dominant pull muscles. They’re muscles that most climbers are very strong in- but are also super tight. If you have a lot of pec tension, a lot of lat tension, and a lot of biceps tension, and you’re also quite strong in those muscles, then that’s going to put excess pull and stress and strain on your inner elbow potentially. That could then manifest as elbow tendinitis, or tendinosis. Treatment for golfer’s elbow needs to involve lengthening and dealing with those upstream tight muscles.

On the other side of that, with tennis elbow, that area is more connected to your tricep muscle group, your back rotator cuff muscles, and your trapezius muscle. Those muscles on climbers happen to be some of the weaker muscles. People with tennis elbow likely need to be focusing on strengthening those upstream back and arm line muscles. I think that’s kind of what I wanted to highlight and explain, that the arm is organized with fascia. I don’t know if you know what fascia is or if I should explain that real quick?

Neely Quinn: Sure.

Esther Smith: It’s the connective tissue- it’s like a stocking that sleeves our entire arm, and it also organizes individual muscles into their shape. It also organizes groups of muscles. When I say there is a myofascial system, it’s the way our limb is organized. We can’t just look at golfer’s elbow, or that inner elbow pain, and say let’s just do wrist eccentrics- those types of classic climber exercises. We also need to look upstream at the system that’s causing the stress and the pull and the irritation at the elbow itself.

Neely Quinn: Okay got it.

Esther Smith: The same goes for the other side. So with this talk, I hope to have a video again, that accompanies this. That shows four essential exercises for climbers to help balance the system. We need a little bit of both. I mean, some people are much more prone to inner elbow problems, some people are much more prone to outer elbow problems. Even if you don’t have an active elbow problem going on, these types of exercises help balance what’s tight and what’s weak. I think they’re really important and every climber should do them.

Neely Quinn: Alright, do you want to tell us the four basic exercises?

Esther Smith: Yeah. One is a front pec stretch. You lay out over a foam roller, and the roller is lengthwise along your spine, and you just get to open your chest and stretch that kind of pec, bicep, lat tension line. Another one is where you are on your knees, and you have your elbows on a bench, and you get to kind of lean into a really good tricep and lat stretch. Those are two really good stretches to lengthen those areas where climbers are generally very short and tight.

The two strengthening exercises- one is laying on your tummy and doing the prone Ts Ys and Is, but we do it in a way that is really respectful of alignment and with really nice activation of the shoulder complex, which not everybody does so well. I really wanted to show that really well. Another one is this serratus push-up, or the rhomboid push-up, that kind helps to strengthen those back muscles that, again, on us, are really weak. They’re essential for stabilizing our scapula or our shoulder blade on our back. We’ll look at those in the video, but those are the four really big bang for your buck exercises that I think would benefit most climbers in general, but particularly climbers who are struggling with acute or chronic tendinitis of the elbow.

Neely Quinn: Whether it’s golfer’s or tennis?

Esther Smith: Correct, because ultimately we need to balance both side of that story. I describe one side of the story being a problem with a lot of shortness and tension, and the other side of the story being a problem with weakness. Every climber needs both of those. I think that that can help us direct why we are engaging in these antagonist exercises. Going back to our last talk, we talked about doing proper push-ups and pull-ups, and having the foundation of those four essential exercises will help you to do those things better. Another thing to talk about when we are talking about golfer’s or tennis elbow, is eccentrics. A lot of people do eccentrics, like the hammer drills, or the reverse wrist curls, right?

Neely Quinn: What’s a hammer drill?

Esther Smith: Hammer drill is where you have literally a hammer or some sort of extended weight, and you’re turning the weight palm up or palm down, have you seen people do that?

Neely Quinn: I was actually doing that the other day.

Esther Smith: Why were you doing it?

Neely Quinn: Somebody gave it to me as shoulder or recovery exercises.

Esther Smith: It’s a great general maintenance exercise for climbers, but if we want to get specific about it, for golfer’s elbow, that inner elbow problem, there’s muscle that connects off of that bony prominence that’s called your pronator teres. It’s specific to that muscle that you’re doing the hammer drill where you turn your palm up really slowly, because it loads that pronator teres muscle. For people with golfer’s elbow, you want to be doing that palm up, or supination eccentric version of the hammer drill.

For somebody with tennis elbow, we would want to be doing the palm down eccentric version of that, so eccentric pronation. That loads this muscle called the supinator. I wanted to try and identify why we are doing these eccentric specific for tendinitis or tendinosis, and which direction we would be doing them given the persons complaint.

Neely Quinn: Okay. So it seems like some of these exercises might cause pain when people have elbow tendinitis, is that true, and how much pain should they expect?

Esther Smith: Another great question. With acute tendinitis, if it’s been going on less than six to eight weeks, you don’t want to do any exercises that actually produce any pain. You want to calm the inflammatory process, and you want to really engage in activity modification so that you can snuff the inflammatory process that’s beginning. You could do really light hammer drills, really light eccentric exercises, but you don’t want to produce any familiar pain about your elbow with those. But it is very different for somebody who has a chronic tendinopathy, and that’s what we call tendinosis. For that you do want to feel some familiar pain or strain when you are engaged in your eccentric exercises. The reason why is because you’re trying to accomplish a very different goal.

For tendinitis that is acute, less than six to eight weeks, you can use ice, activity modification, all the anti-inflammatory measures that you know how, to try to get that issue to resolve as quickly as possible. In that case you might want to take time off from climbing for a few weeks and let everything calm down at the first sign of irritation at your elbow.

If it’s been going on for more than six to eight weeks, the process changes from an inflammatory process to what we call a degenerative process, so now the tendon is no longer inflamed, it’s actually becoming weaker with time, and we get this disturbance of the integrity of the tendon matrix. If it’s been going on longer than six to eight weeks, we are engaging in our eccentric exercises with a different intention and purpose. We want to help the body to repair that damaged tendon, and to do that, we have to reinstate a little bit of a micro-inflammatory process. We would want to produce some familiar strain there, because then you know that you’re targeting the right tissue, but you only do five reps of your exercise. After you’re done with your exercise, you should feel no lasting discomfort.

Neely Quinn: What does that mean, no lasting discomfort?

Esther Smith: It means that within ten minutes, you should go back to a zero baseline- no pain or discomfort after you’ve done your eccentric exercises. And just to clarify, with golfer’s and tennis elbow,  you have your hammer drill, and I said which is more appropriate for which condition, but you also have your twist bar exercises, or the reverse wrist curls. A lot of people do those, where they pull weight back with their wrist and then they slowly lower it out, or they pul weight forward with the wrist and they slowly lower it out. Have you seen people do that, or have you done that?

Neely Quinn: Yeah, mhm.

Esther Smith: If you’re dealing with a chronic tendinosis, then you would be doing these eccentrics in addition to the hammer drill stuff. You’d be doing just five reps of it, and ideally your spread those exercises out across your day evenly, so you’re actually doing three to five different little sessions of five reps of your eccentric exercises. What you’re doing is telling your body to continually repair that tendon, across your day. As you become stronger, you’ll be able to up your load. The whole process of remodeling a chronic tendinitis or a chronic tendinopathy, takes in general about six to eight weeks. Let’s say you start with five pounds, maybe by six to eight weeks,  you’re eccentrically lowering out ten, fifteen, twenty pounds. You’ve progressed to that only if the load that you’re at no longer produces any familiar stress or strain. It’s quite different- if you’re acute, no pain, rest, ice, anti-inflammatory protocol.

If it’s chronic, you need to reinstate the healing process. We call it remodeling the tendon. And you need to kind of remind the body to engage in that healing process across your day, and across a six to eight time period, regularly, to recover from that condition.So with the tendinitis, they’ll rest for three weeks, and then what? And then they should engage in the same eccentrics but under a light enough load that they aren’t feeling any familiar pain or strain directly at their issue. Or at their area of issue.

Neely Quinn: Should the also do it a few times a day?

Esther Smith: With the acute, that can be just a once a day thing. And again, all of theses suggestions I’m making, I’m trying to make them really general, because it’s hard to provide general protocol strategies. With the tendinitis, you’re kind of maintenance-ing maybe once a day. But with the tendinosis, you’re going to want to do your eccentrics, just a a few reps, five reps, throughout your day, three to five sessions evenly space throughout your day.

Neely Quinn: Would you say a person with acute tendinitis- when you say rest for two or three weeks, you mean don’t climb at all?

Esther Smith: I would say really back it down to a level where climbing isn’t producing any pains or unnecessary irritation at that spot. What happens is people develop that little nagging pain at the inner or outer elbow, and they climb on it, and it just sticks with them, rather than engaging in the right therapies to kind of snuff it and not have it be there. You don’t want that nagging pain to go on for six to eight weeks, because it’s suddenly become chronic on you. You know what I mean? It’s probably best, if you feel that, to immediately engage in activity modification. The other thing I wanted to point out, is that in addition to those local treatments, the eccentric exercises, maybe the local massage therapy, things like that, you should be dealing with the upstream problem, right?

If it’s a golfer’s elbow, you need to be getting into that bicep, lat, and pec tension, and dealing with that. And probably working on your shoulder girdle stability. If it’s the tennis elbow problem, you need to be looking at your triceps, your trapezius, and your external rotator cuff muscles. So somebody in that acute situation would need to be saying “Well why is this friction happening at my elbow, and what can I do about it in a more global sense?”, than just stopping climbing, or just trying to treat where the pain is. We need to look at it in that more global perspective.

Neely Quinn: Right, yeah.

I’m just going to pause here for a moment and let you know a little bit more about something else that can help you guys be stronger and better climbers. At TrainingBeta, our goal is to make training as accessible and as easy to do as possible. We’ve created a bunch of training programs for you, so you can just open up your phone, computer, or whatever device you use, and follow instructions and get stronger. So if you’re a route climber, we have a route training program that’s monthly, and it’s about fifteen dollars a month, so it’s really affordable. You get three unique workouts every week, and you go through six week cycles of power endurance, finger strength, performance phases, everything you need to be a stronger route climber. We have the same thing for boulderers, it’s our bouldering training program, it’s also a subscription program. It also gives you those three unique workouts, and it’s just for boulderers, so all of the drills are going to be on boulders instead of routes, and vice versa for the route program. So all of those programs, those two programs and everything else that we offer can be found at trainingbeta.com, and at the top you’ll see training programs and you can check them all out in there. Alright, back to the interview.

Neely Quinn: So I have a friend- and I have plenty of friends who’ve had elbow issues as we all have- but one of my friends had it for five months. She finally went to the guy who does my bodywork, Steve Melis. He does extremely painful deep tissue work, and now she’s climbing again pretty hard, and the pain is going away. What do you think about bodywork and acupuncture concerning tendinitis and tendinosis?

Esther Smith: It can be entirely helpful, and I think in many cases essential, to couple it with what you’re doing with your own treatment strategies. That deep tissue work, what it’s doing for one, is bringing blood flow to the area. She had it chronically- right? So she needed to reinstate that healing process, so she needed new blood to get into the area to deliver all of those repair troops- the ones that can break down that old tissue, rebuild new tissue, and get the waste out of there. The local massage, whether that’s done by a body worker, or an Arm Aid, or any of those self massage tools that we have- we’re trying to get blood flow in there, and we’re also trying to reorganize that tissue to make it linear again, and more organized and more resilient to the loads that we are going to put on it. You get a bunch done at a bodyworker.

Acupuncture is doing the same thing, it’s bringing blood flow, it’s changing the energy in the area, changing tension patterns a lot of times. Dry needling is also an awesome modality for it, because that helps to loosen up those triggered, tight, banded muscle tissues. All of that is super good for tendinitis. That can be done for the acute, or for the chronic. I think a lot of times with the chronic, you’re going to have to employ some of that eccentric loading to really get the tendon to ultimately change, repair, and be lastingly better. It’s a combination of all those things.

Neely Quinn: I want to give people- I know we have a lot more to talk about- but I really want to give people a really clear roadmap. I know everybody is different, but if somebody has golfer’s elbow and it’s not chronic, but it’s acute- how often to they do the exercises and what are they reps and sets like?

Esther Smith: For golfer’s elbow, acute, less than six to eight weeks. You need to be really cautious about how much load and force you’re putting on it, so activity modification is essential. That means you need to figure out if you should be resting flat out for a week or two, getting some bodywork, applying some ice, your anti-inflammatory protocol. That’s number one. You should probably start to engage in some loading of that tissue, so for golfer’s elbow you would be doing eccentric wrist flexion. This is where it gets complicated to describe, but you would probably be doing that and the hammer drills. Ten reps, one to three sets of each, one time a day. Then you need to be stretching, and you need to be working on your antagonist strength. You really need to be doing your chest opening, your lat stretching, and you need to be working on getting really good engagement from your shoulder girdle. That’s where your four essential exercises I’m going to show you are going to come into play, and those can be done once a day. Some good stretching, some good self massage, and some off the wall antagonist strengthening.

Then for the acute tennis elbow, it’s the same thing, you’re just directing your eccentric exercises on the other side of the elbow. They’re going to be doing eccentric wrist extension. They’re going to be loading those extensor muscles appropriately that way, and again it’s the same protocol for those. You’d be choosing the other side of the hammer drill for that, and you’d probably be focusing on dealing with the line that’s a little bit more affected with that group. Tricep issues, trapezius tension, and the weakness of the rotator cuff.

Neely Quinn: Same kind of reps and sets?

Esther Smith: Exactly. It’s just that golfer’s and tennis elbow are affecting different muscle groups, so you have to dial in what your problem is and what muscle groups you really want to focus on. I think the key there is to look upstream and downstream. With that said, for acute tendinitis, rice bucket exercise through a series of wrist, finger, forearm motion, can be super helpful. I’ll be putting a video out on that as well, and we’ll use that for our finger talk. So rice bucketing for our finger strength, wrist strength, can be super helpful for the elbow. For somebody in that acute phase, I would also say rice bucketing a couple times a week would be awesome.

Neely Quinn: You mentioned the Is Ys and Ts on your stomach. What would be the sets and reps for that?

Esther Smith: Sets and reps should be delineated based on how fatigued somebody is. If you do ten reps, you should feel tired enough from that effort that you want to take a rest, and that becomes the different sets. Anywhere from ten to fifteen reps, and one to three sets of on the tummy exercises would be really appropriate for that. That’s no weight, that’s just using your arm weight.

Somebody who is more highly conditioned, maybe they would add one to five pounds in their hands in that exercises and then dial in their sets and reps accordingly given their effort. Most people get enough fatigue doing that right with just body weight. I kind of went through the sets and reps a little bit in the video, so that will be helpful for people.

Neely Quinn: Okay great. Any pointers for proper form for Is Ys and Ts?

Esther Smith: That’s why I wanted to show it in the video, because that’s one exercise that isn’t done super well. The big pointer there is that our shoulder blades, when we are doing those on our stomachs, prone Ts Ys and Is, is that our shoulder blades shouldn’t be moving a lot. They should be pretty stable on our back, and we learn to move our arms with really stable shoulder blades- that’s kind of the point of the exercise. The other point of the exercise is to not activate your upper traps a lot, but to use your middle lower traps, your rhomboids and your serratus muscles. Which, through some of the queuing that I give in the video, people are more likely to engage those appropriately than if they just kind of lay down and start lifting their arms arbitrarily. There’s a lot of mental focus and attention that goes into doing that well.

Neely Quinn: It seems like you could really injure yourself if you do that wrong.

Esther Smith: I also mentioned in the last talk that I’m developing this website called selftreatment.com, and we made a video on tennis elbow and golfer’s elbow, so that we get really specific on all of these parameters. For the eccentric work, the antagonist work, the self massage, we go over what we think is almost everything you need to know to effectively self treat for these two conditions in these videos. Those will be available on selftreatment.com.

Neely Quinn: Awesome. I’ll put a link to all of these things into the episode page for you guys to watch. The videos sound like they’re going to be perfect. It is really hard to explain these things in words, so I think that will be really helpful.

Esther Smith: And kind of going back to your original question, should you feel pain when you’re doing these exercises? Somebody in that acute scenario should feel nothing at all. When you’re that chronic scenario, the only reason I say that you should feel pain is because that signals that you’re stressing the right area. To get that tendon to remodel, and to change, you have to inflict a little bit of that stress so that the body is signaled to repair it. If you stay under that load, you won’t get the repair process that you’re looking for. We call it produce your familiar pain, but no worse after. That means within ten minutes of doing the exercise, whether acute or chronic, you should feel no lasting pain, soreness, or issue at all when you walk away from those.

Neely Quinn: Okay, and so after ten minutes, if you do still have pain, that means that you’ve used too much weight, or you’ve done too many reps?

Esther Smith: Yup. In that chronic scenario, it’s literally five repetitions, and you space it across your day. It’s a totally different set and rep parameter for the chronic situation. I think that’s where people don’t treat their chronic tendinitis as well, because they’re trying to bust out all these exercises all at once and then leave it for the rest of the day, and then the healing and remodeling doesn’t occur. You have to remind the body, and that process is going to take six to eight weeks at least.

Neely Quinn: So be patient.

Esther Smith: Be patient, and advance your load accordingly. When that five pounds gets too light and you don’t feel it anymore, then you go up by a few pounds, or you go up to a ten pound weight, or use those Flexbar twisty bar, because they’re in a graduated resistance and those are awesome for both golfer’s and tennis elbow to do the wrist eccentrics.

Neely Quinn: With tendinosis, should they be climbing?

Esther Smith: I think it’s important- and we talked about this in the first talk- is that we should try to be at a zero baseline. If we are going to be climbing, when we check in with our elbow, we check in with ourselves, we don’t have any chronic soreness, tensions, stiffness. We are going into climbing feeling good at our particular body part that’s injured, and if we climb, we aren’t making that area light up or get worse as a result. Most of my people that are in the chronic world, which is most of the people that show up. I don’t think I’ve actually treated that much acute tendinits, because most people kind of let that sit around and it’s six to eight weeks before they come to physical therapy. I’m trying to encourage them and say alright, if all you can handle right now is two pounds of resistance, then it’s going to be pretty tricky to climb without making that worse. Sometimes they need a week or two to kind of start to load up the tendon, get it a little bit more resilient, and then they can start climbing in a graduated fashion that matches their progression with their exercises and weighted resistances. The stronger the tendon gets, the harder you can climb. You’re just walking that line, you’re climbing to a point where it feels good on your body and you’re not worse after.

The sneaky thing with tendinitis is that you feel it a little bit at the start climbing a lot of times, it kind of gets better with more climbing, then you get slammed after or the next day, it’s super achey, sore and inflamed. You don’t want to always go back and forth on that process, you want to just keep a nice gradual healing process. Just let climbing kind of match that. Most of my elbow tendinitis clients keep climbing while they’re healing, they just have to back it down a bit, especially at the beginning. Then they begin to ramp it up.

Neely Quinn: Man, you need to have some clones of yourself all over the United States [laughs].

Esther Smith: At least I’ve got two other gals working with me. A lot of people ask who they can see- I’ve gotten a lot of emails from all over the country. It’s hard to recommend other physical therapists that I’ve never met or known, but if you look for one that is certified in the McKenzie Method of mechanical diagnosis and therapy, they know how to do these types of therapeutic protocols. Even if they don’t completely understand climbers, they understand the physiology of a problem. If you go to the McKenzie Institute website and look for a provider in your area, they would be the ones I would trust the most to be able to understand what the problem is with a tendinitis or tendinopathy and give people the appropriate protocol for that.

Neely Quinn: Does that mean that every other physical therapist doesn’t understand how to treat things?

Esther Smith: No, it just means that there are a ton that of that aren’t certified in the McKenzie method, but I just think it’s a training system that I can hang my hat on, and say that we all should be doing an equal quality of work and we all understand the body in a similar way. I’ve had a lot of people come to see me with these elbow issues and they’ve been to physical therapy, and there were couple things that didn’t go well there. One, they weren’t given the appropriate parameters of their exercises. So if it was a chronic thing, they weren’t told to do it five reps a couple times a day, advance your load appropriately over six to eight weeks, and they also were treated too locally right at that problem. The therapist didn’t really help them to understand that the elbow issue is likely caused by more of an upstream or downstream problem. Or its because of their movement patterns and they aren’t hanging right, or they’re tweaking themselves in their training program.

I think if we can look globally at it and we can look at the local physiological problem, then you can get treated really effectively. You just have to have a therapist that’s kind of thinking along those lines.

Neely Quinn: Before we run out of time or go way far over, I want to talk about joint derangement and pain coming from the neck. Let’s talk about joint derangement.

Esther Smith: Okay cool. Again the derangement- it’s a weird word but it just means on off track joint. Here’s an example- I just had someone last week who was climbing in Spain, and she was just belaying her partner, and her partner was boinking to get back up on a steep climb. That boinking event kind of shock loaded her elbow, and for several days after that event her elbow felt really sore, really stuck, and full. She couldn’t straighten it or bend it all the way. She was wondering, okay, am I developing the start of some tendinitis, because it actually hurt around the tip of her elbow. It definitely could have been tricep thing or muscle tissue thing. She said she’d had tendinitis before and that it didn’t feel quite the same. And it’s quite common- people will think they have a tendinitis, but it’s actually a joint problem. The way that you can know is- does your joint, does your elbow have a hard time straightening or bending? In a classic tendinitis situation, without a joint problem, there should be no loss of motion when you fully bend it, or fully straighten it, or fully turn your palm up or palm down. In a joint derangement, when it’s a joint problem running the show, you will find a loss of that passive or active range of motion.

For her, we didn’t do anything in terms of this type of loading strategy that we just described for a tendinitis. Instead, we had to look at how to move her joint at the elbow in a way that would clear that obstruction or that problem that she developed from that one episode of boinking. So, what we did, was looked at her movement preferences from her elbow, and discovered that if she repeatedly straightened it with some load, etc, that we could clear that elbow problem and it got better in a week or two. It will get better faster too, than a tendinitis or tendinopathy. Joint derangements usually get better in a handful of weeks, and get better quite rapidly.

Again, the derangement term is a term that McKenzie therapists use, so if somebody is out there listening and they’re like “Oh man I have that, I can’t bend or straighten or bend my elbow, maybe I have joint derangement, maybe it isn’t a tendinitis”, you do need to hopefully go and get diagnosed and screened effectively for that. A McKenzie therapist can do that, because again, we kind of all speak that same language.

The real key there is a loss of passive or active range of motion, usually the pain is a little more diffused, kind of vague around the elbow. A tendinitis or tendinosis is really pinpointed, someone can point to their spot. And every time they engage it’s this on off type presentation of pain. In a joint derangement, it might be more of a constant ache- you don’t need to necessarily be gripping something to feel it. That’s another common one I see a lot. Climbers are funny, because they don’t even know that they couldn’t bend their elbow, and they’ve had a joint derangement going on for a year or two, I’ve seen. We can still get that better in a few weeks if we do the right exercise. It’s kind of wild in that way.

Neely Quinn: What about chiropractors in this situation? It seems like maybe sometimes joints get stuck- I don’t really know the terms- but a chiropractor may be able to put it back into place. I’ve had that happen.

Esther Smith: Yeah, exactly. A chiropractor could have been totally appropriate in that scenario. She didn’t need the joint to be manipulated in that situation, and most people don’t with a derangement. They just need to know how to move the elbow to get it unstuck on their own, and that’s where that’s too complicated to talk about. I just wanted to kind of say that that’s number two frequency for problems that I see, is that the joint is the issue and it’s not an external soft tissue tendinitis or tendinosis.

Neely Quinn: Okay great. And then coming from the neck?

Esther Smith: Yeah, coming from the neck, and this also happens a lot. People, again, a specific client example. She’s late 20 something year old climber, and she has a primary complaint of outside elbow pain. To her that felt like a tendinitis, but she also has a little bit of numbness down the arm in a certain location, and she has pretty pronounced neck stiffness and tension. What was interesting was, as soon as we started treating her neck, all of her elbow pain resolved- even though it looked and felt to her like a tendinitis. So if you have, in that scenario, any range of motion difficulties, chronic or acute neck stiffness or tightness, shoulder blade pain, and you’re kind of dealing with this nagging elbow issue, then you might need to be treated at your neck, and engage in no therapies at all from the elbow itself because it’s coming from a different place.

Neely Quinn: nd neck injuries are a little bit, I don’t know. They’re not easy to deal with. What would you suggest- like who- obviously you could help. But who else can help with that?

Esther Smith: Well again, any McKenzie therapist. You can go to the same McKenzie institute website and look for somebody in your area. The average physical therapist should be able to deal with this too, really well. But chiropractic could be helpful in this situation if you know a good one, bodywork in this case as well, just freeing up any of those soft tissue restrictions and tension to help loosen up the neck. Usually the elbow pain coming from the neck will be a result of something kind of pinched at the neck itself, or deranged at the neck. You need to kind of get those things back on track, and when you unload that tissue, that tissue no longer sends that referred pain back to the elbow. I would say bodywork, chiropractic, and physical therapy are all people you could go to if you think your problem is coming from your neck.

Neely Quinn: This girl you were describing, did she have a car accident, did she have some acute trauma?

Esther Smith: No, no. And that’s the common thing, is that it just kind of comes insidiously, no apparent reason. If you have that going on, the traumatic issue, that’s when you want to see a physician and potentially get an x-ray or MRI, and that goes for the elbow too, not only just the neck issue. But she didn’t, it was non-traumatic. It had just developed, and she was dealing with it for a long time. I see a lot of that, where people have this persistent, lasting, general one sided neck tension shoulder issue, and then there’s some elbow stuff, and there’s some finger stuff going on all on that same side. In that case, we have to treat everything a little bit.

I think going back to the original topics that we’ve discussed- hanging right, hanging with really good form, doing your exercises with really good alignment and form, and then climbing that way- all of that helps to facilitate not getting these insidious, no apparent reason injuries from occurring. Hers just came out of nowhere, but she credits it to climbing related issues, and postural stuff at work, and driving, and things like that.

Neely Quinn: All of the therapy work and all of that is great, but if you have a job where you’re sitting at a computer all day, or you’re doing some repetitive work all day, it seems like that needs to be adjusted more than anything, right?

Esther Smith: Totally right on that one. I think that a lot of times because our sport is so intense and stressful, we kind of blame it on climbing. But even the case of elbow tendinitis, I’ve seen almost as many people aggravated by their desk work, or their gardening, or their home chores, and their elbow even more than climbing. We have to address those other environmental and work influences for sure.

Neely Quinn: I wanted to mention one other thing, which is a totally different reason for elbow pain, and it’s from personal experience. I thought I had elbow tendinitis for a while, and it turned out it was a food sensitivity to nuts and seeds. I was eating a ton of cashews, way too many cashews- I was also gaining weight from it. I don’t know what- I have a bunch of food sensitivities, and I’ve just weeded them out one by one. This one just kind of dawned on me, like, maybe this pain is coming from food, and this is a good I’m eating a lot of. So I took out the cashews and had almost immediate relief. My husband did the same thing, and his mom did the same thing. I think a lot of people have a lot of sensitivities to nuts and seeds. I’ve also done this with some of my clients with success. It’s just something to consider. I’m not saying that this is you, or that this is a for sure thing, but it’s something to explore if you do eat a lot of foods like that, that can be inflammatory.

Esther Smith: That’s a super good point, and that’s one of the reason Iw anted to study nutrition. I found that there were these clients that had these inflammatory type presentations or conditions, but they weren’t responding to the normal PT stuff. It turned out to be either allergy influenced food sensitivities, or gut inflammation that results in systemic inflammation. I think one thing, if you’re one of those people that has that going on, and you’re not responding, or you’re prone to having that occur in a lot of different body parts, then you should definitely look at your diet, nutrition, and those food sensitivities for sure. That can be driving an inflammatory process systemically.

Neely Quinn: One thing- this is kind of funny- I mean it’s not funny at all- but I met this woman this weekend at a party. She’s celiacs, so she’s completely sensitive to wheat and gluten. Her elbow blows up and get super painful when she eat gluten, and she calls it her “glutenator”. I don’t know. It can be so many different things. These have been really great suggestions and really great guidelines, and I can’t wait to see the videos. Hopefully these will be really helpful for people, thank you.

Esther Smith: You’re welcome, I think it will be good. I guess just know that everybody is an individual, and I kind of have to have a disclaimer that I can’t cover this in an exhaustive way, but at least we talked about some different ways of looking at it than people have heard before- some different solution strategy parameters. And thinking about what we are doing on and off the wall that might be contributing to these chronic or acute injuries, and how we can kind of reverse those if we do things better.

Neely Quinn: Yes. Oh, one last thing. It seems like with the neck stuff, belay glasses would help a lot of people. Do you agree?

Esther Smith: Yeah, that’s a big deal, for sure. Belay glasses, and also the same kind of shoulder complex attention, that we would give to our shoulder. If we think about taking care of our shoulder, that’s also going to really take care of our neck. A lot of us are upper trap dominant, we do the shoulder shrug thing, and we effort that way. Doing things to strengthen the shoulder girdle and support that, takes a lot of the force and pressure off of the neck. Everybody that comes in with a neck issue that’s a climber is going to get shoulder girdle strengthening, they’re going to be taught to hang right, and then they’re also going to be helped with balancing what’s tight and what’s weak. Same for the shoulder people, same for the elbow and the finger people.

I think realizing that it’s all a system, it’s all connected via this myofascial web, and we just really need to be focused on whey we are choosing exercises and how we are going to balance that system, so we don’t do those in a lazy or sloppy way, but in a way that has a lot of intention. Hanging right helps the neck too, because a lot of people get super scrunchy in their neck when they’re hanging like a bag of rocks.

Neely Quinn: It seems like some people look up when they hang- what’s the deal with that?

Esther Smith: You want to look straight ahead. Another thing is that people are looking down all the time at their timers, I’m seeing that too. People just don’t think about their structure when they’re hanging. Try to put your timer right on a tall box or something, so you can have a sight downward gaze. One thing on hanging right, Eva Lopez has what’s called the Eva Lopez Training Station on YouTube, and she has a how to dead hang appropriately on there that I looked at yesterday, and it’s awesome. She talks about all of the little nitty gritty on how to hang right. In addition to the one that I’m going to put out, I think checking out the Eva Lopez “How to Dead Hang” on her YouTube channel would be a really good call for a lot of people

Neely Quinn: Yeah, great. Okay. Well tell us one last time where we can find you online?

Esther Smith: You can find me at grassrootsphysicaltherapy.com. I have a Grassroots Physical Therapy Facebook page, and then the new self treatment website is grassrootselftreatment.com, or selftreatment.com just by itself. That’s where we are going to have these how to self treat videos on golfer’s elbow and tennis elbow specifically, and very oriented towards climbers. That should be a great resource. And we’ll get these videos posted on TrainingBeta.

Neely Quinn: And if you’re in the Salt Lake area, you can see Esther in person.

Esther Smith: Yup. And like I said, searching for other providers, I think a safe bet is the McKenzie certified providers, so you can jump on that McKenzie Institute. Or hopefully word of mouth will bring you to a good physical therapist in your area, or to a good bodyworker. If you can kind of couple, like create a little team between an acupuncturist, a bodyworker, and a PT, and a physician if you need one, that creates a really good network for people to be supported so it’s not falling on one person.

Neely Quinn: You just described my team [laughs].

Esther Smith: I have a team too, and I think another thing is, we talk a lot about injury prevention, and we do the best we can to prevent injury, but all of us get tweaked. I get tweaked too. It’s how we deal with our injuries and those tweaks, and not letting them get chronic. There’s so much more easily managed in that first six weeks, and if we do that really well, then we won’t develop these really chronic things that take us from our sport. I think that was a really good conversation on how to deal with things more acutely.

Neely Quinn: Then our next conversation will be about fingers, in what do think, about a month?

Esther Smith: Yeah, let’s shoot for that.

Neely Quinn: Okay, thank you very much Esther!

Esther Smith: Thanks Neely!

Neely Quinn: Alright I hope you enjoyed that interview with Esther Smith. You can find her at grassrootsphysicaltherapy.com, and then her new website is selftreatment.com, and that’s where you can find those tutorials on elbow issues if you have decided that you want to do something about your elbow pain.

Coming up on the podcast, I’m going to have Esther on again in a month. But I’m going to interview my friend Danny Robertson, who is an awesome climber who lives on the Western Slope in Colorado- he climbs in Rifle a lot, and he listens to the podcast quite a bit. He did his nemesis route, The Crew this year, which is 14c. I was really psyched for him and I wanted him to be able to share how he got so strong, and so much stronger, in order to do that route. I’m interviewing him next week, and that will be out pretty soon.

Something big is actually going on on TrainingBeta. We have Mercedes Pollmeier has been to be our online personal trainer. It used to be Kris Peters, and he was too busy to do it, so I sought out the best trainer that I could find. Mercedes has been on the podcast before, and she’s a trainer out of Seattle. She used to be in the Denver area, she’s worked with athletes of all kinds, she has a masters in human movement, and she studies the crap out of training and knows her stuff. I had her train me, for three weeks before I sprained my finger, and what I found is that she’s super thorough, she’s straight to the point, she takes into consideration my whole situation. My training program was very easy to follow, it was catered to my shoulder injury and all of the equipment that I had available to me to use. So if you want to train with  her, she’s doing four week programs or three month programs- she really likes to work with people long term. She will work with you wherever you are in the world, and it will be catered to you. You can find that at trainingbeta.com/mercedes.

Other than that, on January 20th, I’m going to have the three new finger training programs. I’m really excited about that, and my friend Dallas Millburn has been working on them to make them really pretty, so thank you Dallas, and I hope you guys like them.

So I think that’s it. Wish me luck with my shoulder, and I hope what Esther does for me works. I’m going to start working with her on Monday, which is in three weeks from now. I’ll keep you posted about that- I tell you guys these things so you can learn maybe something from my experience, and hopefully you can. Have a good week, and thanks for listening all the way to the end!