Golfer elbow (?)

I probably have overdone something in my training as I have symptoms of what I think is a (hopefully light) golfer elbow inflammation on my left side.

I have self-diagnosed it, but it is on the medial side of the elbow, just very slightly above the joint, the location matching very well with what I found with google (yes, it does not substitute proper medical training, I know).

What should I do to treat it and which movements should I avoid?

Note that I had some problem with my left wrist before, see this thread

Thank you in advance for the advice.

Generally we try not to give medical advice here, as it's not a substitute for proper medical evaluation and care.  There is lots of information online if you care to investigate, but I would recommend seeing a PT or your doctor.  Good luck!

Take a look at this thread

Thanks Kai, I am going to have a look. AND I am seeing may doctor next week, just in the incredibly unlikely case (sarcasm intended) that a google-assisted-self-diagnosis by an incompetent could prove wrong...

Guido,

I think I may have mentioned it in the other thread, but there is (was hopefully) a reason (beyond the cost) why climbers, who frequently experience medial epicondylitis, have been hesitant to visit "health care professionals" to seek help. All too often the professionals understanding of the injury/pathology and treatment methods proved woefully inadequate and "rest" was the only advice. I experienced that myself and wish the amount of useful information on the web would have been as large as it is now - it would have saved me a lot of time off

Thanks Kai, I agree, professionals who do not understand the sport very often do not give terribly good advice. I have seen many PT after a knee fracture, and many of them were happy enough to leave me with a range in flexion which is "enough for daily life". I have kept working on it, and I can now manage an uncomfortable seiza - and I will keep working on it.

But in this case I really may have misinterprets my symptoms - in fact someone at the gym suggested it could be biceps/triceps attachment. So I am seeing the professional to get a diagnosis, then I agree that the official route is not necessarily the only one or the best one.

A climber friend of mine had an "elbow" problem which a compentent doctor/physio realized to be a biceps tendon issue. He quickly fixed it with high rep biceps curls... 

Good luck for your appointment!

Similarly I've had tender elbow regions on occasion that have been resolved by thorough biceps stretches, and lower back pain resolved by piriformis stretching. 

So, I saw an orthopedist yesterday, and the diagnosis was "Enthesiopathie der Ellenbogenregion", I think that is quite generic for an inflammation of the tendon/ligament in the elbow region. Unfortunately the doctor spoke very little English, and I speak no German so communication was a bit hard. I was put some bandage from the forearm to just above the elbow which I should keep for three days, and then I should put some kind of elastic band.

The diagnosis was done quite quickly, basically she moved my wrist/arm in various directions. The only one which caused my discomfort was dorsiflexion (? starting with the back of the hand facing up bending the wrist so to bring the back of the hand facing the chest) under resistance. Just dorsiflexion without resistance does not cause me discomfort. I have not localised the precise movements which cause me pain (not strong pain anyway at least for now), curiously I often feel it if I yawn or breath very deeply - surely because of some associate movement of the shoulder/arm.

If anyone has some more precise advice based on the above I would be very grateful!

Exercise-wise I was thinking of interrupting H1 in total and also most of my current F1 exercises

FL PE2 ok FL im Not
sPL PE1 not sPL im ok
HBP PE1 not, HBP im NOT
RC PE1 not, im not

SL PE1 Not, iM ok
MN PE1 ok, iM not
SLS PE1 ok, iM ok

I am not sure about stretches, I imagine most of FS to be fine and most of TB not. Am I being too conservative? I do not think I can decide what to do and what not based on discomfort/pain as I felt none and still managed to injure myself

Seize this opportunity to work on strenghtening your mobility limitations with the stretch programs, and your core/compression strength w/ FL/SL variations.  Oftentimes injuries are actually a boon, and we must not waste the chance to work on other areas of weakness.  Might be a good time to get some running or jump roping in as well.  Get better soon.

5 hours ago, Guido Franchetti said:

So, I saw an orthopedist yesterday, and the diagnosis was "Enthesiopathie der Ellenbogenregion", I think that is quite generic for an inflammation of the tendon/ligament in the elbow region.

Yes, you're right - the term translates to "insertion tendinopathy of the elbow region".

Did you talk to her about physical therapy?

Thank you Douglas and Leonhard.

No, I did not get any indication for physical therapy but I have been referred to a PT which I will see on Friday.

Having both golfers and tennis elbow chronically for years, I can offer some advice.

The best thing that has ever worked for me to get the inflammation down and the pain to go away was not resting, taking pills or acupuncture or any other treatment! It was to continue training , however on the exercises that cause the pain, to go very light until you can no longer feel the pain and continue training at that intensity. Over a few weeks you will notice it getting better until you can start increasing intensity again. be careful not to advance to quickly or it will return very quickly!

Also using shoulder extension stretches helped wonders in stretching the tendon (for golfers elbow).

The latest advice for elbow tendon injuries is to train pain free. You physio will be abke to guide you in what to do once you have been assessed.

Hi Guido, 

did you get any useful advice from the PT? From my experience with Golfer's elbow (and a friend's with tennis elbow) I can second what Marcus said. So yes while it is sensible to think of an injury as a chance to work on other things as Douglas suggested, don't let that push you towards not focusing your energy on getting better, which for best/fastest results will mean some training. Don't be too afraid to try things out beyond your conservative list above. If you try something once and then observe carefully how the elbow feels as you do it and the day after, you will not risk overdoing it I believe and will be able to do as much as the injury allows at this time.

I got so mad reading the "diagnosis", which really is nothing but a fancy way of saying your elbow hurts. That's exactly why people scour the internet for answers/solutions to medical issues, because you will often find better advice there than from a run of the mill doctor who has no idea of sports demands on the body and related overuse injuries...

Hi Kai, thanks for your message, indeed the diagnosis was not very useful. I did not get much out of the PT either, but that for a reason I agree with: I am seeing him also for rehab after a hip and knee fracture happened last year and he decided to focus on those first, without putting too much meat on the fire.

I have tried going a bit less conservative, the problem is that the single exercises seem to be fine, but after the workout I feel more sore. Also, often the exercise by itself does not hurt, but while doing it I happen to move/contract other muscles and that hurts a bit, so in some cases I decided to stop the exercise altogether. I suppose I should have tried adding other exercises one at the time rather than trying to get back to the whole F1 workout at once...

Anyway, the thing is has still not healed but in everyday life I do not notice it at all, so hopefully it will not take too long. 

At the moment I am doing some wrist and shoulder stretches and a few headstands - but definitely less volume and intensity than what I would do in a full H1 workout. I am still skipping push ups, RC and SL (My disliking of SL may have something to do with it...), and I do some of the TB stretches but not the full workout. At least I can focus more on the remaining exercises, which are improving (but after FL and MN one after the other my core is pretty fried!).

That's good to hear that at least you are seeing progress (from my experience it is a good sign indeed that in everyday life you are not feeling the injury anymore) and at the same time are still able to continue some training. Even a little bit is so important as it will keep you in the habit of training vs. establishing other habits to fill the time void if training is impossible...

Best of luck to you!

I see a few people are following this thread, so I thought to add a follow up on how things worked out for me. Unfortunately I forgot to do this before, so I do not remember the timeframe very well.

For some time, probably about 4 weeks, I followed the very cautious regime described above,

Quote

 

Exercise-wise I was thinking of interrupting H1 in total and also most of my current F1 exercises

FL PE2 ok FL im Not
sPL PE1 not sPL im ok
HBP PE1 not, HBP im NOT
RC PE1 not, im not

SL PE1 Not, iM ok
MN PE1 ok, iM not
SLS PE1 ok, iM ok

 

or something similar. This was beneficial at first, but pretty soon seemed to make no difference for my injury. By 4 weeks or so I was fed up of following such a limited training with no apparent benefits, so I started to gradually go back to a full Foundation training. I was surprised to find that no exercise, not even pushups, made the elbow feel any worse. Gradually I also included back the handstand wrist work.

While no exercise I was doing caused direct pain, sometimes I could feel a bit of pain in unsuspicious situations, e.g. while grabbing my ankles to gain more compressions in the stretches pike work. Of course this had nothing to do with the pike itself, but with some contraction of the arm muscles when pulling from the ankles. Since this happened for maybe 4 seconds out of the whole stretch duration I kept doing the stretch.

For a very long time (I think 3-4 months) it seemed to me that the injury was neither getting better nor worse: it was not bothering me in everyday life, I would only feel it occasionally in workouts, but it seemed not to be getting any better. Actually, it was probably fading into the background, as at some point I realised "hey, I used to have some pain in the elbow from time to time, but I haven't had it for a long time now, maybe I am healed :)".

So, based only on my personal experience I would say:

1) As long as you see an immediate benefit, it is probably good to back off from most of the exercises involving the elbow. If you know what you are doing, which muscles do what and where exactly your injury is, you can probably be quite a bit less cautious than I have been.

2) When that stops to have an effect, it is probably time to get back to work. Do this gradually, paying special attention to exercises particularly involving the injured part. However, it is probably non necessary to be absolutely paranoid about this: I kept doing some exercises which occasionally bothered me a bit (but like in one rep out of 15 because of an unusual contraction).

3) These things can take a damn long time, and on a day to day and even week to week basis it may seem that nothing is happening.

For anyone reading this: this is just my personal opinion based on what happened to me, and I am not a physiotherapist or otherwise expert in these matters.

Thank you for sharing this, Guido. It quite resembles my first experience with "elbow tendonitis". At the time, I injured my elbow with climbing. I thought "ok, at least I'll now be able to mountain bike a lot more" but that was wrong because the gripping of the handlebars especially downhill proved too much and aggravated the elbow. In the end, I more or less paused both those favorite sports for nearly a year while getting into yoga a lot. 

What I know now though is that while that break was good for me and I'd never want to miss that discovery of yoga and things that led me to, recovery from the medial tendinitis/golfers elbow I had did not HAVE to take that long. The current approaches to this condition, which are not yet known to all even in the medical world, allow a much quicker healing and a very quick return to exercise. These approaches are eccentrics performed beyond the level of discomfort. I have written about it in other threads including this one with some resources, I just want to post here again so people don't feel they need to resign themselves to a lengthy time off. Aggressive rehab as soon as you notice your condition will yield rapid benefits with golfer/tennis elbow type "injuries" and similar tendinopathies. I know from my own experience with (admittedly milder) recurrences. 

I just got rid of golfer's elbow this past week.  I got it by incorporating Daily Deadhangs for shoulder health.  My grip could hold for 30 seconds, but it was way too much for my forearms at the elbow tendon.  After 3 days, I had golfer's elbow.  From reading the web,  I learned it was a too much / too soon exexercise ( overuse ) injury that's best to get resolve early than train through pain

What worked for me

Reduced volume :

I backed down my hang frequency from daily to every other day, got some hooks to space out the unload on my elbows every other workout. 

Reduced Intensity:

Rather than dong full weighted hangs, I supported some of my body with feet on ground.

I plan to methodically add load and frequency til I can do daily hangs full body weight without elbow pain as my soft tissue adapts.  I caught it early, and took about a week and a half to get rid of it.  IMHO - isolate the exercise that caused it and back off intensty/frequency to let your golfer's elbow can heal.