Golfer's elbow?

Hi all,

I've a horrible feeling I've developed something along the lines of Golfer's Elbow? I have tenderness around the medial epicondyle (knobble on the inside) of both elbows, extending slightly down/out diagonally toward Pronator Teres, as best I can tell. I have no professional diagnosis, so I could be wrong about it being tendonitis, and might be a muscle strain/tear, etc? I am aware that a whole bunch of flexors, and pronator teres, share a common tendon of origin in that area.

Some facts:

> Painful pronating hands with arms straight (pronated, supinated and neutral at wrist)

> Painful pressing with fingers/1st knuckles with arms straight (extended, flexed and neutral wrist)

> Hardly any discomfort with both the above when elbows bent, which I find odd!?

> It is not really tender under direct pressure, and doesn't ache or throb during the day

> I often forget about it until I do something that aggravates it

Has anybody come across this with gymnastic training? Or have any useful advice?

I've a feeling it's probably been caused by a combination of both gripping hard while hanging straight armed (which would also be pronated) and pushing hard through first knuckles during handstand practice. The exercises I have been doing most of the time running up to becoming aware of the injury* were: handstands against wall, chin-ups (palms facing) and HLRs from bar.

* When I say injury, I mistook it for PWO soreness for a few weeks before I realised it might be something a little more serious. It really flared up following getting a little bit too 'CrossFit' during some MetCon, which included a load of assisted pull-ups (palms away)!!!

It is very frustrating, and quite unfair - I have never even played golf!

Cheers,

George.

High volume pullups cause golfers elbow, and pretty much anything in gymnastics. Anyone who does one-arm pullup work will get it. I also got a bad case once doing heavy crush curls with two weight plates. Those muscles are small and can only take so much abuse. I've been told the only cure is to wait it out. Stop the activity that caused it and train around the problem until it goes away.

On the positive side, if you let it heal right, you'll be less prone to it in the future. Think of it as a form of conditioning for the elbow . Good luck!

That's really useful to know. Thanks Joe.

George.

George,

My recommendation is to rest, rest, rest. And then more rest. Do not perform any conditioning that aggravates your elbow. Allowed to heal, the tendonitis will resolve itself and soon become a faint memory. However, continuing to train on it before it is fully healed will result in the tendonitis becoming chronic and from then on being a constant companion.

Spending a great deal of time stretching the wrists and forearms will help to alleviate the discomfort. In addition, two to three grams of vitamin C and one to two teaspoonfuls of fish oil per day will aid in reducing the inflammation.

In addition, once the majority of the pain has subsided, the judicious use of negative reverse curls done with a relatively light weight with 10 second negatives for 3 x 5-10 reps will greatly increase the speed of healing. Please note that the steady negative here is the key. Be sure to use a full ROM.

This instance of tendonitis, as with most, seems to have been caused by an injudicious (my apologies for being direct) increase in overall volume. An example may help to illustrate how increasing volume too rapidly can significantly exceed the body's ability to recover. For example, a 170lb man does 3 sets of 8 reps of pull-ups for a total workload of 4,080 lbs moved. When the perceived effort of this workout becomes relatively easy, he may now be bitten by the bug to engage in some "metcon"; where in addition to the form being much looser, the swinging etc being much greater, he will now substantially increase his overall volume of work done as well. The standard metcon seems to revolve around 100 reps; for 170lb this would equate to 17,000lbs. As is easily seen, this is nearly 13,000 more lbs of work being done during the same exercise within the same workout; an increase in the workload by over a factor of four.

In retrospect, obviously a situation with a high potential for an overuse injury to occur. I have also frequently made similar mistakes (I am nursing a pulled rib at this very moment from spotting athletes much larger than myself :roll:; if only my foresight was as good as my hindsight!

Yours in Fitness,

Coach Sommer

Thanks for the advice Coach, and no apologies necessary ...injudicious was a very tactful way of putting it!

The irony is I was reading up on exactly this kind of thing when I realised I had the injury. I'm pretty relieved that I've caught it nice and early, and fully intend to rest up and come back more intelligently when healed ...and hopefully nearer the 170lbs in your example than the 220lbs in reality! :roll:

Fortunately there's plenty of other stuff to be getting on with in the interim. Hope your rib feels better soon.

Cheers,

George.

Coach Sommer said:

George,

In addition, two to three grams of vitamin C and one to two teaspoonfuls of fish oil per day will aid in reducing the inflammation.

Hey Coach, I know you're an extremely busy man, but I was wondering if you could expand on this a little more. I know about the whole issue with Linus Pauling and megadosing to prevent/combat the common cold and the recent (and some old but unheard of) research which finds this myth false.

If your body only has the ability to use a maximum of 200mg of Vitamin C a day, how does megadosing to two or three grams affect anything?

Over the years, I have found, through both personal experience and through working with my athletes, that supplementing with one to two grams of Vitamin C a day when dealing with a soft tissue trauma greatly accelerates the rate of healing. Why this should be so effective, I do not know. However there is often a disconnect between results that are observed "in the field" as it were and the discovery of why it is so "in the lab".

Yours in Fitness,

Coach Sommer

Is this manufactured or natural supplementation and would it be a good experiment to test on my own injury (left distal (insertion) biceps tendonitis/osis *self diagnosed - non professional*)

I'm skeptical, but given I don't have your experience it seems logical to test for myself. I don't have much to lose besides some negligible cash and my pride (knowing I'd be helping to fund a money machine whose marketing practices I have come to despise).

One last question, did your athletes hault all training until 100% recovery was acheived? Was there any PT work you prescribed?

I greatly appreciate all your feedback and time

Charles

Vitamin C and tendon repair

Here's a link on that subject.

You might find it useful:

http://www.springerlink.com/content/f41g434v74203337/

Happy training

Brusi

Collagen and Vit. C

I found another useful link

http://www.vitamincfoundation.org/collagen.html

That first link I found intriguing, however the second link provides no information. It explains that Vitamin C is used in the process of creating procollagen, but does not back up at all the reasoning that more vitamin C must mean more or faster collagen growth.

Also, going back to the first study, would there be much of a difference between ingested vitamin C and localized injection vitamin C?

I prefer independent research and generally speaking never assume anything stated via book, website, tv from the tested organization is the whole truth.

I'll do some more research once I get out of class, thanks though! Much appreciated.

Charles

Hi Coach Sommer (and anyone else who might be able to help),

Coach Sommer said:

Do not perform any conditioning that aggravates your elbow. Allowed to heal, the tendonitis will resolve itself and soon become a faint memory. However, continuing to train on it before it is fully healed will result in the tendonitis becoming chronic and from then on being a constant companion.

What would be considered aggravating the injury? One interpretation might be: anything that makes it worse? Another might be: anything that causes discomfort, however mild? I only ask as I am feeling really de-motivated with so many limitations on my training (i.e. not being able to grip anything or press with fingers). If the only solution is a complete lay-off then so be it, as it needs to heal - I just don't want to be overcautious without it being necessary. :?

If it is a case of discomfort is OK, but pain is bad, do you have any recommendations on some kind of pain scale that can be applied? Even things like the recommended stretching cause some discomfort at times, not to mention a whole bunch of everyday activities. For example there are levels of post-workout soreness you know you could safely work through, and levels of soreness that you know means "don't even think about it" :shock:

Thanks,

George.

George,

You're right, stay away from movements that cause elbow pain. Usually, it's recommended a perceived pain of 5 and above (on a scale 1-10) should be avoided. One of the problems with golfers and tennis elbow is the inability to properly stretch those small muscles (because of the one-dimensional nature of the elbow). Hence the development of myofascial (?)

restrictions. Do you know any good Active Release (ART) practitioners? I've had good results with this.

Be patient, and good luck!

Thanks JoeS, that's useful info.

I'll look into the ART stuff, but I'd be surprised if there's anything out in my (rather remote) neck of the woods. The vit C, fish oil, rest and some massage seem to be helping a lot, and they feel better already. Just got to make sure I don't get back into training too hard too soon, and have it flare up again!

Cheers,

George.

For anyone who's vaguely interested, my elbows are feeling much better after ...just over a week! Thought it was longer!? I took the Vit-C and fish oil as recommended, and kept up the stretching. I also made a big effort to clean up my diet, as I've been really slack lately, and too many carbs can promote inflammation anyway!

I tried some light pull-ups at the gym today (bodyweight -30kg) at a nice controlled tempo, and no problem. I also did a few sets of partial ROM HSPU as well (about 6'' from floor) and also no problems. Will leave it a day or two before doing anything else, and see how they fare.

N.B. I have been doing a few light Deadlifts (around 70-80kg?) and one-armed behind-the-neck barbell presses (Pavel style) over the last week as it didn't seem to aggravate anything ...those barbell presses are hard to control, and don't half hit the old deltoids!!!

Cheers,

George.

George said:

I tried some light pull-ups at the gym today (bodyweight -30kg) at a nice controlled tempo, and no problem. I also did a few sets of partial ROM HSPU as well (about 6'' from floor) and also no problems. Will leave it a day or two before doing anything else, and see how they fare.

Hi George!

It's really great that the elbow is feeling better. I just wanted to include that I did feel the same a week and two weeks after my initial injury three months ago without being on the supplements. It's been a week for me as well there was no pain during very slow controlled pull ups. I still plan on waiting a full 100 days before ever trying anything extensive on it.

Lookin good though!

Charles

Hi Charles,

That's good to hear.

Did I miss something about the "waiting a full 100 days" thing? :shock:

Cheers,

George.

Great news George

Haha, oh no. After doing some light research I've been hearing a lot about 100 days for full collagen development. This is an extremely helpful website I found to do some research on tendons.

http://www.tendinosis.org/ (wfs)

Charles

Oh no!!! ...my left elbow's feeling a little achey after my experiments this week, so will be taking a little more time off from direct work. Not really surprised about that, more that the right one is still AOK!

Oh well,

George.

Coach,

I have developed mild tendinitis in my right wrist, on the outside of it (pinky side). I am refraining from doing any false grip work (muscle ups) and pressin on floor, I'm using rings for pressing work so as not prevent putting pressure on my wrists. I am just wondering will stretching my wrist do it good or damage it?

Ed

Ed,

Stretching will definitely help you but in the beginning all you need is rest from your painful activities - once the pain started to disappear you can focus on a rehab program - maybe wrist curls and stretching.

Everything that has a beginning has en end too - the pain doesn't make an exception as well.

Please see the following post for an essay and video pertaining to wrist issues.

Yours in Fitness,

Coach Sommer

Coach, I have a question about something you mentioned in your first post. When you say exercises that don't aggrivate the elbow, do you only mean the exercises which causes pain or discomfort during or after preforming them, or all exercises which the elbows are involved in? Is ok to train with a weight which dosen't cause pain or discomfort, or will this just make things worse? It would be nice to get clear answer on this because it basically draws a line between what is ok and what isn't, even though the answer is probably obvious. Coach or anyone else?

Thanks.

EDIT: The question was already been answered, i should probably read the thread next time before I ask a question :oops: .

Oh, Andull. Hahaha! This defines necro-posting!