Strength imbalance causing elbow tendonitis?

I'v had elbow tendonitis for quite a while now, I'm sure it's to do with my forearm muscles as opposed to the triceps since it started with shitty guitar technique, but it soon affected my exercise, things like pull ups and push ups are a no go.

I tried resting it for months, it didn't work.

I went to the physio, and they told me I had horrible scapular stability, the cause of many seemingly unrelated problems, that had prevented me exercising for quite some time- however no matter what I did, the tendonitis in my elbows came back.

I'm now wondering if it's down to a strength imbalance between my forearm flexors and extensors, I climb and do a lot of pulling activity, my flexors are undoubtedly stronger than the extensors, could this be a cause of the seemingly chronic tendonitis?

I'v been doing eccentric reverse wrist curls and rotations (slowly) to try and fix the problem, does anyone know if this will work?

What did your physio say about your elbow? Did you mean he said that scapular instability caused it? And what are you doing about that scapular instability? That is a question a physio could easily answer... I suggest you get them from him if possible.

But yes, imbalances do cause these problems, just look up tennis elbow for an example. Assuming you have a similar problem, the first step is rest. Then fix what is causing it (bad habits, flexor overuse, extensor weakness) then strengthen it in a balanced way. You probably need to add in isometrics and concentrics to your extensor strengthening

Hope that helps!

They physios I'v been too about my various issues have been really vague, since then I'v read up on lots of physiotherapy stuff and now know exactly what they meant, but they essentially ignored the tendonitis (after confirming that it was tendonitis), and went for the more serious scapulae issues, which I'm fixing with all manner of scapulae specific exercises (trapezius, rotar cuff, serratus anterior, etc).

I'm glad to hear I'm on the right track with my tendonitis re-hab anyway.

You are definitely on track by doing your own research. You should really grill your health care professionals, they tend to get lazy. Not only does it make the process quicker the more you know, it keeps them sharp.

I'd suggest getting a heavy duty rubber band and a bucket full of rice.

When you talk about your forearm flexors, I assume that you have medial epicondylitis, aka. golfer's elbow. In the long term, when your symptoms are gone, I would guess that the wrist prep stuff in H1 would be very beneficial to you - They are to me, and I used to have a pretty bad case of golfer's elbow.

Apparently, when you have been dealing with golfer's elbow for a long time, and it keeps coming back whenever you ramp up activity, chances are that the tendonitis is no longer acute (a response to a recent injury), but chronic, aka. tendonosus, which require a somewhat different strategy to recover from. This is because permanent tissue degeneration has occured, which must be reversed through gradual introduction of inflammation.

In my case, something that really helped rehabbing that was: 

1: Rest from any pulling exercises / work for ~6 weeks.

2: Allowing the affected area to get very slightly inflamed, so that the inflammation process would begin to repair the affected area. IME, this can easily take a year. You can control this process by doing an exercise that causes you to feel a very slight pain (1-2 on a scale of ten). Doing this consistently, and adding intensity very gradually should enable you to get your strength levels back up.

Good luck, tendonitis is a b*tch.

Golfer arm results from a biceps too short compared to the brachialis, so its tendon is loaded too much. The way to go is: Strengthen brachialis more than biceps, stretch biceps more than brachialis (they cannot be stretched nor strengthened independently). How to do that best depends on your exact problem - I know it in both arms but have to work them differently. Campussing short moves may work wonders.

H1 wrist prep has really help my medial epicondylitis. I find it helpful going with easiest progressions and doing double the suggested reps. Gets a lot of blood flow to that area. Also I do eccentric wrist rotations with a leverage bar. And finally hammer curls for 20 reps to warm everything up before I boulder.

Christoph said:

Golfer arm results from a biceps too short compared to the brachialis, so its tendon is loaded too much. The way to go is: Strengthen brachialis more than biceps, stretch biceps more than brachialis (they cannot be stretched nor strengthened independently). How to do that best depends on your exact problem - I know it in both arms but have to work them differently. Campussing short moves may work wonders.

Normally I'd think that suggesting campusing or climbing at all for tendonitis is crazy, but ever since I've stopped climbing I've had elbow/forearm problems, so maybe its related? Unfortunately its bad enough I now can't get back into climbing to see if it will fix it....

As for stretching the bicep more than the brachialis, would something like this work for that? http://www.youtube.com/watch?v=JZ0h7YRkIrU When I saw an osteopath he showed me this to pin down specific forearm muscles to stretch them independently and across the entire muscle, and I guess it has the extra bonus of soft tissue massage. It hasn't helped personally, but maybe I was just applying in the wrong place

Christoph said:

Golfer arm results from a biceps too short compared to the brachialis, so its tendon is loaded too much. The way to go is: Strengthen brachialis more than biceps, stretch biceps more than brachialis (they cannot be stretched nor strengthened independently). How to do that best depends on your exact problem - I know it in both arms but have to work them differently. Campussing short moves may work wonders.

I'm not quite following you, unless we are talking about two different things: Golfer's elbow, vs. Golfer's arm, which I haven't heard about before.

Golfer's elbow, aka. medial epicondylitis, is an inflammation of the insertion point, the medial epicondyle, of the tendons of the hand flexors. Pretty sure that the bicep and brachialis tendons are not involved in this condition.

You're of course right, these are different animals. Recently I've seen the inflammation of the biceps tendon (John Gill is famous for that) discussed as "golfer's arm" which is imprecise in two respects (only, both result in a pain in the inside of the elbow). So please ignore my above post.

I'm in full agreement with RAVN's comments. My method of inflammation was through prolotherapy. Four rounds of injections spaced about 3-4 weeks apart. It worked surprisingly well, but not quite 100%. I believe sugar water injections are a preferred choice to cortisone- based on personal experience, and from warnings that cortisone can weaken tissues. According to my Doc., prolotherapy has proven to work well on the elbow joint in particular, but patients have also seen relief in knee joints, wrists, fingers, and other areas. Given a choice between chronic tendonosis or a bone fracture or break, I'd probably take the latter.

Fingertip push-ups, and wrist rocks (demonstrated in H1) seem to activate tissues tied to the medial side of the elbow joint. I want to believe that those exercises are a form of preventative medicine.

Evilllamas said:

I'v had elbow tendonitis for quite a while now, I'm sure it's to do with my forearm muscles as opposed to the triceps since it started with shitty guitar technique, but it soon affected my exercise, things like pull ups and push ups are a no go.

 

I tried resting it for months, it didn't work.

 

I went to the physio, and they told me I had horrible scapular stability, the cause of many seemingly unrelated problems, that had prevented me exercising for quite some time- however no matter what I did, the tendonitis in my elbows came back.

 

I'm now wondering if it's down to a strength imbalance between my forearm flexors and extensors, I climb and do a lot of pulling activity, my flexors are undoubtedly stronger than the extensors, could this be a cause of the seemingly chronic tendonitis?

 

I'v been doing eccentric reverse wrist curls and rotations (slowly) to try and fix the problem, does anyone know if this will work?

Hey there, I can totally empathise with your situation, I've been there myself. I also used to do a lot of pulling as I was a climber for a few years in my late teens/early twenties. I got to the the point where I had no transport to go climbing so I got myself a BMX and started riding flatland which is when my elbow tendonitis started to flare up. I found it was from the repetitive motion of landing the front wheel back down and with 100psi in the tyres any shock absorption had to come from my arms.

With hindsight I can see that I spent the majority of time pulling... I was rubbish at pushing and why would I want to do that? I was a climber! I saw the doctor and got the usual 'rest it' recommendation which didn't work and continued to get problems for about 9yrs. Getting a referral to a physio on the NHS is an achievement in itself and not always that successful as they often treat the symptom and not the cause in my experience.  I figured that was it, my body was weak and I was resigned to frailty for the rest of my life.

About 3yrs ago I decided to get fitter, came across this website, started educating myself and some of these issues started to rear their ugly head again which created a lot of doubt about whether I'd be able to make any progress with all this stuff. It's sortable but it will take time and you'll need to go back to the basics to rectify what's going on.

Yes, there is likely a strength imbalance between your extensors and flexors but to only look at your forearm is shortsighted (not wanting to sound rude here). As your physio noted you have horrible scapular stability so you need to work on fixing that as well. as it's likely contributing to your issues. Isolating muscles can help but you need to look at more global patterns rather than what's going on locally. Once you can see what's going on globally you can start breaking it down in to more localised issues. If I could start over again I'd have done self myofascial release with a lacrosse ball on my forearms and around the scapula daily along with plenty of stretching. When you're out of pain you can start to think about strengthening again but start from the very basics. F1 & H1 are the best place to start and will help you build mobility which you then build stability onto. Both would be ideal but if you can only afford one I'd go for H1. 

I've embedded a few videos which could be of some use... you may or may not have seen them already. On Joshua Natermans video I'd focus on the T and Y positions he mentions and make sure you put a towel under your elbow when you do the palms down variation as it can cause quite a bit of stress.

JasonDupree said:

You are definitely on track by doing your own research. You should really grill your health care professionals, they tend to get lazy. Not only does it make the process quicker the more you know, it keeps them sharp.

Spot on but it's a bit of a balancing act. Go easy grilling them as they may not be responsive to it but let them know you have some knowledge and that you want to educate yourself and understand. Tell them about your observations and suggest your own thoughts based on your knowledge. It's likely quite refreshing for them to deal with someone who is keen to understand and learn about their issues... well... it would be for me if I were a physio.