Golfer's Elbow and Pullup

[Mattia Picoco]

Hi guys i've got an elbow tendonitis in my right elbow ,caused from things that i wasn't prepared for(like german hang,ring support,weighted pullup,planche work,ring muscle ups...). The ecography show that i have a modest inflammation in the tendon. The pain isn't really high(1-2 in a scale of 10) and i feel it only in pulling movement. My physiotherapist is curing the tendonitis with ultrasound therapy,she told me that i should not try a single pullup in my entire life after the pain will disappear. Should i trust her?

[Mikkel Ravn]

No, she is wrong. However, you need to start very, very slowly and work your way up again. Do not accept elbow pain, and if you do experience it, lower the intensity of the exercise.

[Alessandro Mainente]

golfer's tendonitis refers to a particular region that is very similar to the inner part of elbows. in this region muscles does not pass to tendon then to bone but there is a particular type of attachment between muscle directly to bone. this not frequent morphology leads to an important reduction of blood flow that cannot be modified.

the condition will improve. usually this is a consequence of very poor conditioning of both extensor and muscles that assist the elbows flexion.

my suggestion is stretch to relax the region, then work on barbell curl with all grips, high reps for at least 3 to 5 months. then  you can return to pullup. unfortunately is you stressed too much the region there is the possibility of scar tissue that could reduce more the blood flow.

[Mattia Picoco]

Thank you for the responses.

@Alessandro:Do you mean bicep curl or wrist curl?

[Mark Collins]

Hi guys i've got an elbow tendonitis in my right elbow ,caused from things that i wasn't prepared for(like german hang,ring support,weighted pullup,planche work,ring muscle ups...). The ecography show that i have a modest inflammation in the tendon. The pain isn't really high(1-2 in a scale of 10) and i feel it only in pulling movement. My physiotherapist is curing the tendonitis with ultrasound therapy,she told me that i should not try a single pullup in my entire life after the pain will disappear. Should i trust her?

You need a new physiotherapist. Ultrasound does not help tendons. You need to appropriately load the tendon so that it can cope with load. A pull up is not a big load once you have done the correct rehab. It is most likely she has never done a pull up in her life and thinks that are hard.

For rehab you generally need to:

1. Do isometric wrist curls or 90 degree isometric bicep curls for 3-5x60 secs at least daily

2. Isotonic strengthening using wrist curls and pulling exercises such as incline rows building to pull ups.

3. Use Foundation rope climb series so you can develop the elbow in a safe manner

4. Do the stretches in handstand one

5. Do regular soft tissue releases of the forearm and biceps.

[Jay Sartorius]

your PT is correct if you...
1) are unprepared for an activity
2) use poor technique
3) lack strength / ROM to perform given skill properly

However you need to ask your self
1) Do you have full elbow flexion and extension (can you completly straighten your elbow, even hyperextend by a couple degrees)?
2) Do you have full shoulder ROM, extension? internal / external rotation.  If not your elbow could be taking more abuse just like knee pain can be caused from a lack of hip ROM
3) serious gut check on form
4) are you strong enough to attempt said skill progressions

If you said NO to any of these that is where you should invest your time. Personally I experenced medial elbow tendonitis (golfers elbow) when I was performing pull ups and chinups with 50LBs extra ILBs for sets of 8.  It was not until I improved my form by gaining more shoulder external rotation and elbow extension did my pain subside.

Tendonitis is an overuse injury, over use injurys happen faster if your technique is lacking (if your missing ROM you probably are lacking technique) or your volume of activity is too high.  It just so happens that the best position to apply force is also the safest position.  You can't ignore your pain.  At least in the begining it is probably worth spending some quality time getting back ROM. or working on the above.

Hoep this was semi useful

[Alessandro Mainente]

Thank you for the responses.

@Alessandro:Do you mean bicep curl or wrist curl?

basically biceps curl. for more appropriate idea follows Mark Collin's suggestion.

[Matthew Mutch]

When rehabbing tendonitis injuries, be very patient and conservative.  If it is a small nagging pain and you aggravate it with more exercise, an otherwise small injury could turn into a chronic injury.  Instead of needing 1-2 weeks rest, re-aggravated injuries may take up to 6-12 weeks of rest.

 

The ultrasound is considered a modality that heats deeper tissue layers.  Such passive modalities do not "heal" the tissues by itself.  They are best used in conjunction with exercise as long as light activity is well tolerated.  Tendons respond best to exercises involving prolonged tension.

 

Light isometric work (like Mark Collins mentioned ) in a painless ROM is a fantastic idea to start rehab.  Slowly build back up to your previous level of activity with isometrics with the elbow in different positions (45,90, 135 degrees).

 

As an aside, I had a small bout with this (as I do golf on a regular basis).  I stopped performing the activity that caused the pain (i.e. golf, ring rows, etc) and rested it for about 2 weeks.  I performed myofascial release on my wrist/finger extensor muscle group, followed the HS wrist stretches, and did my isometrics.  I felt back to 100% in about 2-3 weeks.  After I was back at full, I worked planche leans (forward leaning plank with elbows locked) and noticed I had to start easy because the brachialis muscle of the elbow was sore.  When I strengthened the brachialis, I noticed my elbow feels even stronger than before.  I know it's anecdotal, but it help shed some light on my medial epicondylitis.

 

Keep us posted on your recovery.

[Mattia Picoco]

I apprecciate your advices guys

Seems that rehab is a general recommendation in my case,i never think that it was necessary ,but is near to three months i've stopped every activity and the pain is still here.

Myofascial movement you described are simply massage?

I've to wait until there is no pain before starting rehab or i can start now?

[Matthew Mutch]

Myofascial release (also known as MFR, pin and stretch, A.R.T. or FDM) is a soft tissue technique that is typically used for more specific tissue mobilization. Youtube search any of the above names to get a sense of what they do. Also, Coach and Cory Fair have both mentioned the benefits of Russian Medical Massage helping his athletes.

This should go without saying, but these do not replace rest, and active rehab, MFR should be used in conjunction with rehab, stretch, etc. If you have rested your injury for at least 3-4 weeks, it may be time to try and start the rehab protocol mentioned above at a light resistance and in a pain free range of motion.

[Matthew Albanese]

I looked up this specific topic as I'm currently dealing with some golfers elbow in my left arm and also some elbow pain in the right arm (though more due to that elbow having been hyperextended multiple times during martial arts training).  I recently completed 5x10 on the elevated row progression, but due to the elbow pain I know it's not smart to continue pushing forward. 

 

These are some great recommendations as far as rehab goes, but one question I'd have is, while I'm recovering and rehabbing this, would it make sense to leave out the rope climb progressions completely (temporarily of course), or would it make more sense to just drop down to a progression that doesn't cause any pain (e.g. back to PE1) and start over?  

 

The other option would seem to be to just substitute the rehab work above (isometrics, wrist curl negatives with integrated wrist/elbow mobility) in place of the rope climb progression work on those days.

[Mark Collins]

Reduce your loading either by less reps and sets on the same exercise that aggravates you. If this does not work keep working backwards through the rope climb series until you find what you can tolerate.