RC PE/6 Tennis Elbow

Hi Everyone,

A bit of background on me, I have lots of scar tissue in my right elbow due to thousands of hours of racket sports. I had multiple bouts of tennis elbow due to tennis and basically had to stop playing because of it.

I have had tennis elbow problems in the past with chin ups, pull ups with a pronated grip have not been as much of a problem. This is why I was nervous about starting RC PE/6...

I started it 3 weeks ago, choosing 30 seconds x 4 as a nice easy starting point. I was very conscious about not starting off at max capacity, and I could comfortably complete 4x30 with no shaking etc. The following week, I progressed onto 4 x 33 seconds, keeping the step small. Unfortunately my elbow has started to hurt.

Has anyone with dodgy elbows managed to overcome RC PE/6, if so I'm interested to hear how they did it? I have been doing 3 sets of Tyler twists per day as prehab for many months on my right elbow. I also know pretty much all the stretches and dumbbell exercises for TE. 

I was thinking of backing right off to 10 second holds, increasing by 2 seconds per step, while doing previous RC progressions (which did not hurt my elbow) to keep my strength. 

I don't think that the generic advice e.g. not strong enough, go back to previous progressions etc. necessarily applies. This is a longstanding injury / weak spot and I was wondering whether anyone with similar issues has mastered RC PE/6.

Any advice appreciated!

Thanks, Mark

Assuming pe1-5 is perfect: I'd run the first block (3x12, 5x12, 3x24, 3x12) a few times. Your muscles might be strong enough, but connective tissue lagging. I believe that is what this exercise is for. If block one is still too much, try cutting the seconds in half.

Thanks Jason, but the connective tissue lagging is kind of the generic advice which I'm not sure applies to my case.

My weaker left arm appears to be conditioned just fine because there isn't the slightest twinge of pain in there. I feel almost like I could do RC PE/1-5 for 10 years with no problem, and then go to RC PE/6 and experience problems (although I'm not going to test my theory!). 

Another example is that a couple of years ago, I played a gentle set of tennis doubles and that was enough to flare my elbow up after 2 years rehabilitation. If I am ever going to master RC PE/6 It's like I need some micro steps transitioning into it to have any chance, which is why I was wondering if anyone with a similarly damaged elbow had ever successfully devised a strategy to conquer it.

If supinated grip chinups is the problem, you need to start out at a much lower intensity = Not bodyweight. I've had a pretty catastrophic case of Golfer's Elbow, where the tendon gave a big crack, and I was out for 12 months.

What helped me was tons of self massage and stretching, and, once the worst pain was gone (some 3 months post injury), beginning to work eccentrics with a very light weight, i.e. in the 1 pound range. I literally had to build back up to bodyweight, and from injury to 90% recovered, probably 18-24 months elapsed.

So, while you may think that you're strong enough, it sure sounds like your body disagrees with you.

Thanks Mikkel. Just to clarify, I haven't done a supinated grip pull up in probably over a year. However, as you know, RC PE/6 is like a SGPU but with a hang instead of a pull.

I do the eccentrics, that is what the Tyler Twist does. I started with the light red bar, and have been using the green medium resistance bar for a long time. I also sometimes do eccentrics with dumbells and I do a lot of stretching. I perform this routine as prehab even when I have no pain. 

I had zero pain in my right arm before RC PE/6, and it's probably 9 months since my last flare up. If I can do eccentrics with a decent amount of weight/resistance, can master RC PE1-5, and have no elbow pain then how would I know whether or not I am ready for RC PE/6?

Anyhow, I wouldn't be surprised if this is my lot and I am permanently unable to progress on RC. Disappointing, but not as disappointing as giving up tennis. If stem cell treatment was more affordable, I would try that (it's around $10,000 over here in Australia).

I'm not saying that you have to abandon RC progressions - I had a very, very bad case (before Foundation even came out), and am now back and currently at RC/PE22 without issues.

I'm just saying that it may take a long time to actually get back.

You must observe a few rules along the way:

Never more pain than a 1 or 2 on a scale of 10. It is alright to have a very, very slight soreness after training, as it is a sign that the area is being inflamed slightly, and therefore being under repair. It is imperative to keep the soreness under control, however: The tenderness should have completely disappeared before the next training session, or you are exceeding your current recovery capability. 

For chronic conditions like the two of us share, simply resting is not enough: The tissue is permanently changed for the worse, and you actually need a slight inflammation to reverse the condition.

It is the accumulated inflammation -> restitution -> inflammation cycles, under ever so slightly increasing loads that will eventually take you back to being healed.

Hi Mark, 

I'm in the same boat with a case of chronic golfer's elbow and torn ligaments prior Foundation since 2013.

I'm following F1 to the T and I'm very curious to see if this time around I can conquer it. I know for sure RCPE6 would be a trigger for me. I hope I will be able to get there and beyond, hoping my damage is reversible with time and confitioning. 

I've been using the same guiding principle of "no more than 1-3 pain" taking into account my total volume, from F1, HS, SS to computer work, which also irritates it!

I can echo both your feeling in that it seems as our muscles could do more AND as it's been said above clearly our connective tissue says "no." 

I'm going by feel and following this "just enough" stimulus/repair strategy and it seems to be working so far. I do bodywork and acupuncture bi-weekly too.

Mikkel very glad to see you overcame it. Thanks for sharing!

You're welcome. It's not fully healed, and will still be aggravated when I do hard one-arm movements in climbing. I guess rope climbs will be the final nail in the coffin for getting totally rid of it.

However, I have a painless 3-4 second front lever, so it's been some excellent progress. I literally could not wash my hair with my left arm, as the pain would just be too much.

#liveandlearn #testosteroneinducedstupidity

Thanks guys. I will experiment and dial RC 6 back to a point where I keep the pain levels very low. Hopefully this is a number > 0 seconds! Good to hear that someone with similar issues managed to push through.

Well done, everyone.  Great advice and attitudes on all sides.

Bottomline; no training thru pain.  If your elbows are excessively sore post workout, then your workout was too intense - regardless of how they felt during the workout itself.

Also feel free to use the 10sec and 30sec templates if initially starting with the 60sec template proves to be too much.  For severe cases of tendonitis consider the following:

1) work thru the 10sec template.

2) work thru the 30sec template

3) work thru the 60sec template

With severe cases of tendonitis it is possible that these steps may still prove to be too intense, so micro-steps may be necessary.

Yours in Fitness,

Coach Sommer

From my experience with golfers elbow:

second what Mikkel says: rest is not the solution, and some slight soreness is ok/desired.

Take your rehab as seriously as you do your training, which also means progressing it. If you have done 3 sets of Tyler twists with the same green bar for a long time, I'd say it's time to step it up in volume and/or intensity if the pain permits and as a goal. The three sets is just what they used in the research, look at it as a starting point for your own exploration

Also explore other relevant movements (similar attachment points of the muscles) and the effect of performing them in a rehab manner (eccentric, or high reps): supination with a sledgehammer-type implement, finger extensions against a rubber band on your condition, not just wrist extension.

A quick update; I have been doing the 30 sec template of RC/PE6 as Coach suggested, with some RC/PE1 thrown in so I don't lose strength. I have also upped the wrist stretches and I know it's early days but so far, so good. The elbow is settling in to a manageable 2-3/10 on the pain scale.

The next part is all kinds of stupid for someone with my condition. I am traveling and the gym that I went to tonight had a rope (I don't have any access to a rope when at home). I was there, the rope was there and one thing led to another  Anyhow, I was too curious and tried a rep of legless rope climb (how much damage can one rep do, right?). It was a bit tough but I managed it. I don't think that I could have done that 6 months ago before starting the program; it shows how much RC PE/1-5 plus a bit of RC PE/6 can do.

On 10/06/2016 at 11:06 PM, Coach Sommer said:

Well done, everyone.  Great advice and attitudes on all sides.

Bottomline; no training thru pain.  If your elbows are excessively sore post workout, then your workout was too intense - regardless of how they felt during the workout itself.

Also feel free to use the 10sec and 30sec templates if initially starting with the 60sec template proves to be too much.  For severe cases of tendonitis consider the following:

1) work thru the 10sec template.

2) work thru the 30sec template

3) work thru the 60sec template

With severe cases of tendonitis it is possible that these steps may still prove to be too intense, so micro-steps may be necessary.

Yours in Fitness,

Coach Sommer

Coach, I have worked through the 30 sec template from step 1 and I am now in the deload week of the final step.

I think that I have mostly kept the elbow discomfort within reasonable limits, and I have been seeing a physio regularly and doing other elbow rehab work (having needles stuck into an inflamed tendon is an interesting experience!). I get the impression that there is slow but noticeable improvement in my elbow. 

Where do you suggest that I start in the 60 sec template? At step 1 or should I pick up roughly where I left off the 30 sec template e.g. start at something like the 4x24 sec step or the 4x36 sec step?

Hi Mark,

While at a lower intensity, the elbow discomfort is still present.  I would recommend repeating the 30sec template again.  Do not consider this strength training - consider it rehab.

In addition, you may want to check out Theraband's therabars; the prescribed exercises are an interesting blend of twisting and negatives.  I have just begun exploring these as well and see potential with these for elbow tendonitis.

Primarily remember that once tendonitis raises its ugly head; less is more.

Yours in Fitness,

Coach Sommer

Thanks coach, it is always nice decreasing the time on RC 6!

I have the red and green Therabars and use them to perform the Tyler Twist. Some months ago they helped to nip a mild case of tendinitis in my left elbow in the bud.

Unfortunately I damaged my right elbow a lot more by playing racket sports and working out through about 6-8 months of progressively worse pain , and it is taking correspondingly longer to fix.  

+1 here (massage therapist with medial elbow tendonopathy/golfer's elbow + related ulnar neuropathy + ??related right forearm oedema. Not a pretty combination.) While golfer's elbow is often irritation of the tendons coming off the muscles that flex the wrists, mine is more the deeper muscles that flex the fingers (as I use these at work) - this means anything involving curled fingers hanging off something is painful. Which is pretty much every element except SLS, for me at present.

I like Coach's ideas about moving to a shorter template.

My self-treatment/warmup is light -> heavy isometrics held for about a minute, times 5 (alternating hands). Then each element, 1 set at a time. If it starts to get any more sore than after the isometrics, I stop the sets. Not ideal, but it at least helps to maintain progress. After training I'll do some ulnar nerve glides and manual ulnar nerve mobilisation.

The only other thing I'll add to the advice given by everyone else is that IF the pain starts get dull and achey along the arm, or if you get numb or tingly feelings in the fingers, get proper treatment (physio/physical therapy). Neural stuff can really set you back and if you're hanging off something and lose your grip because a muscle won't activate, more injury could result.

@Mark Goedeke Have you found dry needling **in the tendon** helpful? I used to dry needle but have stopped. I've never needled a tendon, and while fenestration is a useful procedure in some situations, I'm not sure an angry tendon is one of them.

Edit: I have found these "Novel movements for the wrist and forearms" quite useful, too. Apart from loading the tendon at different parts along its length these movements also mobilise neural tissue around the tendon.

It might be a bit early to say how much the needling is helping because I have only had around 5 or 6 sessions so far and I am also doing isometric holds and wrist extensions with dumbbells. The physio is also performing manual therapy to release the muscles in the forearm. 

There is progress because my pain has slightly decreased whilst increasing the load. How much of that is attributable to the needling I don't know. I can confidently state that it's not much fun having a needle stuck into an angry tendon and then "agitated"!

On 8/31/2016 at 2:11 PM, Coach Sommer said:

In addition, you may want to check out Theraband's therabars; the prescribed exercises are an interesting blend of twisting and negatives.  I have just begun exploring these as well and see potential with these for elbow tendonitis.

In my experience they work great. It's virtually the only thing that has alleviated some golfers elbow I developed.