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Leonard Wuest

Triceps and wrist tendonitis

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Leonard Wuest

Hello Everyone,

I want to start Foundation One, bought it and the progressions look great, but unfortunately I have preexisting injuries, which prevent me from starting it.

 

2-3 years ago I didn´t know much about bodyweight training and just immitated exercises I saw on youtube. I did a lot of clapping push ups and elbow levers (Of course bad form). I didn´t warm up, did it multiple times a day, no rest days. Very stupid. My wrists started to hurt (on the flexor side) but I pushed through the pain even, though they hurted pretty badly. It just was fun to do these exercises. What a mistake!

 

Wall Pushups and Incline Pushups were good and my wrist pain vanished, but I never went past knee pushups. The pain came back. So I did push ups on the fists, which felt better I worked up to close push ups this way.

I also worked with triceps extensions and tiger bend push ups, but these hurted my elbows (the triceps tendon). But I ignored the pain. 

 

I went to a couple of doctors, made x-rays and mri. They couldn´t see anything, except maybe a mild synovitis in the wrists. But the pain was there and I couldn´t even stand up, while pressing myself up with the palm. I can feel the pain in the tendons, so it´s probably chronic tendonitis (tendonosis). The doctors told me I should rest and don´t do any upper body training, even pullups hurted. So I rested, for 5 months now. The pain is still there. 

So I followed the advice, Massage of the muscles and light eccentrics/stretching.

I´m also wearing wrist and elbow wraps to keep the tendons warm.

I ´m not sure it´s the right thing to do. At least it doesn´t get worse from it (I think).

My wrist injury happened now more than 2 years ago, but I didn´t rested it consequently back then.

Triceps Injury was not longer than a year ago.

Both weren´t really acute injuries or accidents, they got worse with the time and became chronic.

What should I do for tendon rehab?

I´m not able to do most of the first steps in foundation one, because of these chronic injuries.

Should I rest even more?

Any advice?

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Ivan Pavlovic

I can feel the pain in the tendons, so it´s probably chronic tendonitis (tendonosis). The doctors told me I should rest and don´t do any upper body training, even pullups hurted. So I rested, for 5 months now. The pain is still there.

Tendinosis can take up to 12 months to pass (maybe even more im not sure compleatly).

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Alessandro Mainente

you are optimistic, tendonitis chronic could take from 6 months to 1 year if you're lucky. 

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Curt Ferson

Prolotherapy works. If you don't mind a needle stuck deep in your elbow/wrists. Helped me anyway.

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Mark Collins

If 5 months rest didn't help how much more rest do you need? Tendons like to be worked but not too much. You could have some symptoms for the rest of your life so you will need to learn how to train with this injury.

Repost in F1 so specific exercises can be discussed and how to modify your training.

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Leonard Wuest

I can´t perform any Upper Body Exercises.

Even something like the cat-cow is impossible for now, because I have to support myself with my wrists and locked elbows.

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Mark Collins

You can do modified versions of the Foundation exercises you are having difficulties with. I regularly have patients do these.

Also get some physiotherapy.

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Leonard Wuest

Is it beneficial to use some sort of eccentric exercises?

If so, what would those be (preferably unweighted)?

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Cole Dano

It was thought that eccentric exercises were best but that's changing and 'regular' exercises may be just as effective. The key is finding the right intensity.

 

Coach Sommer's wrist prehab is in H1.

 

Other tools that can help are

 

Rice Bucket

Rubber Bands

PowerBall

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Curt Ferson

I should have clarified that prolotherapy with ozone is probably what you need. The ozone promotes faster healing. With chronic conditions like yours, At home methods for rehab will take much longer to work on their own (speaking from experience), but are also necessary.  Good luck and get healthy.

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Mark Collins

I should have clarified that prolotherapy with ozone is probably what you need. The ozone promotes faster healing. With chronic conditions like yours, At home methods for rehab will take much longer to work on their own (speaking from experience), but are also necessary.  Good luck and get healthy.

Dr Barton sums it up well.

"Understand that load is the key, other treatments are just helpers. People commonly make the mistake of thinking an injection will cure them, or surgery might, the reality with tendons is that there is no substitute to progressive exercise and load. Anything else that is added and this includes massage, dry needling, orthotics, etc., etc. are helpers or adjuncts and will most likely only work with a good loading program. This definitely injections and surgery! - See more at: http://www.completesportscare.com.au/2015/04/top-4-treatments-achilles-tendinopathy/"

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Curt Ferson

Hey Mark. Nothing to disagree with there at all. I had chronic tendon issues in my elbow for many years. My doctor suggested physical therapy. I worked with elec. stim, light exercises, stretching, massage, ice/heat, anti-inflammatory pills, and I even gave acupuncture a try for a few sessions. My work is physical, so pain persisted for years. Doctor administered cortisone several times- each time providing relief for about 6 months- then the issue returned. I have also learned that cortisone can weaken tissues if used frequently-so it was probably a bad idea. I suggest prolotherapy or prolozone for areas of poor circulation and chronic pain because after 3 treatments coupled with frequent stretching, the pain was barely noticeable and I was able to start the foundation program. I did not need to alter my physical work during this time.  It's been nearly two years now without a flare up! So credit the progressive loading in the foundation program, and give an assist to the healing stimulation from prolo. Since the procedure is relatively inexpensive, safe and effective, I will not hesitate to use it again as needed.

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Leonard Wuest

So what are good options for some load?

Push ups against a wall and high rows?

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Mark Collins

You need to start on an isometric exercise for 2-6 weeks. You could do a wall push up and hold the mid range position for 3-5x60 secs daily.

Start back at F1. Modify HBP/PE1 and sPL to against the wall.

It is normal for pain to be aggravated for 24hrs. If it is more reduce the load again.

Without seeing you in person bear in mind this is general advice. With your level of pain and limited function you are best served by getting treatment from a Physio that is up to date with the latest tendon treatment.

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Leonard Wuest

You need to start on an isometric exercise for 2-6 weeks. You could do a wall push up and hold the mid range position for 3-5x60 secs daily.

Start back at F1. Modify HBP/PE1 and sPL to against the wall.

It is normal for pain to be aggravated for 24hrs. If it is more reduce the load again.

Without seeing you in person bear in mind this is general advice. With your level of pain and limited function you are best served by getting treatment from a Physio that is up to date with the latest tendon treatment.

I tried isometrics in the wall push up position today and it felt great. Really increased the blood flow and didn´t hurt.

Started with the feet very close to the wall. So during those 2-6 weeks, should I place more load on the tendons by gradually stepping further away from the wall and eventually do them on an incline?

 

Should I do stretching as well?

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Mark Collins

Good to hear. Work towards the incline as it will add more load. If your symptoms increase for more than 24 hours then reduce the incline.

Don't worry about stretching the tricep. By stretching the tricep you will compress the tendon, which will aggravate it.

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Leonard Wuest

Good to hear. Work towards the incline as it will add more load. If your symptoms increase for more than 24 hours then reduce the incline.

Don't worry about stretching the tricep. By stretching the tricep you will compress the tendon, which will aggravate it.

Should I do the isometrics  once or several times a day?

Any rest days?

After 2-6 weeks. should I work on eccentric or concentric wall push ups?

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Leonard Wuest

Can I start the stretch series (front and middle split) in the meantime or do they require the wrists and arms to work?

Also can I work just on the Single Leg Squat Progression in Foundation 1 for now?

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Mark Collins

As you feel better reduce the isometrics to use as a warm up before your workout. Wall push ups are done concentric/eccentric. There is no benefit for the tendon in doing eccentrics only.

Stretch series is ok to start. If you are tight you will be doing a lot of support on the arms, which is an isometric tricep exercise. You may need to reduce the time for each stretch depending on how you feel.

SLS is ok to do.

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Leonard Wuest

As you feel better reduce the isometrics to use as a warm up before your workout. Wall push ups are done concentric/eccentric. There is no benefit for the tendon in doing eccentrics only.

Stretch series is ok to start. If you are tight you will be doing a lot of support on the arms, which is an isometric tricep exercise. You may need to reduce the time for each stretch depending on how you feel.

SLS is ok to do.

I went to see another doctor, and it is likely that I have some sort of rheumatic problem.

I have to take Naproxen (NSAID´s) twice a day and soon be getting some physio.

Should I continue with the isometrics?

The point of doing these is to slightly inflame the tendons again, so they can heal (I think), so isn´t it counterproductive to take anti-infalmmatories?

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Leonhard Krahé

The point of doing these is to slightly inflame the tendons again, so they can heal (I think), so isn´t it counterproductive to take anti-infalmmatories?

Out of curiosity (being a med student myself) - did the doctor tell you that it's the plan to slightly inflame the tendons again? That concept is completely new to me (which does not have to mean anything, of course).

In that case I guess the NSAIDs are prescribed to keep the inflammation to a slight degree and from going overboard.

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Leonard Wuest

Out of curiosity (being a med student myself) - did the doctor tell you that it's the plan to slightly inflame the tendons again? That concept is completely nehave tow to me (which does not  mean anything, of course).

In that case I guess the NSAIDs are prescribed to keep the inflammation to a slight degree and from going overboard.

No, that is not what my doctor said. I´ve read about this method somewhere on this forum.

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Mark Collins

Tendon pathology does not respond well to anti-inflammatories as inflammation is not the problem.

The goal of the isometrics is to improve the loading capability of the tendon and there is also an analgesic effect. So keep them up.

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Mark Collins

No, that is not what my doctor said. I´ve read about this method somewhere on this forum and in an article of Stephen Low here: http://www.eatmoveimprove.com/2009/08/on-tendonitis/.

Tendon injuries have been renamed tendinopathy rather than tendonitis due to the lack of inflammatory cells found.

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