Coming off an Elbow Injury

On 2/2/2017 at 8:08 AM, Leigh Kettle said:

 Really disappointed to have  spent a lot of money on seeing "specialists"  for none of them to actually diagnose what's going on. So for the time being im self managing it and just trying to take things easily . It's weird cos one day will be fine and then I'll do the same thing another day exercise wise and it can feel different again . Such a frustrating issue .

t

 What are your symptoms like? Maybe I can help you self diagnose. I understand the frustration's, I bounced around from doc to doc for about 14 months until I found someone who actually knew what they were doing. Hang in there

- Ryan 

Hey Ryan 

thank you for your support 

my symptons are strange to say the least  . I'll try and explain best i can . They don't seem to fit into the conventional tennis or golfers elbow as the pain seems to come from within the elbow at a point roughly central(in between )!the usual medial and lateral issues that people get . I've never come across anyone on here or speaking to people (even specialists) that seem to have had similar issues which is frustrating . At least with tennis and golfers elbows there's a world of advice that you can view online 

both my elbows are affected 

pain doesn't manifest during push-ups and rows in my foundation one exercises so I've cautiously continued with these. This is why yours and others comments has confused me somewhat as you aren't able to do some exercises without pain . This never seems to be an issue to me, in that im able to perform things that don't hurt in the same way .

what i would also add, I have really scaled back since starting gst to what I used to do training wise .  . So to not have any improvement since starting gst  also baffles me especially  as the exercises I just mentioned don't hurt me so they shouldn't be aggravating it further. I would have expected a little improvement maybe ... But I do understand it can take a long time to repair more chronic damage so this i can accept 

That said however the following things are the exceptions 

1. sustained holds in the straight arm position can aggravate it as soon as I release the straight arm hold . For example more than around 10 reps of Scap shrugs can start to "burn" deep inside the elbow especially  when i release it as it returns to its deloaded state . Short handstands are ok but I darent do long ones as im certain this will aggravate as it has done in the past . 

2. when my arms are bent for long periods ie on the phone when I straighten them they feel stiff and a little sore 

3.!when I bend my arm quickly to fully bent  (like in snapping motion ) I get a short sharp stabbing pain within the elbows.

At rest there is no pain, when I lift things bent arms that can hurt as can doing things like putting my hands behind my head and interlocking the fingers as this puts my elbows in full flexion, always like a short sharp stab

surprisingly to me the only thing that seems to make my elbows feel normal and "healthy" despite  all of the massage work and that I've had is a rub of the anti inflammatory gel voltarol .i felt a bit of pain  more than usual a couple of weeks ago so I just rubbed it in see if it helped and it did weirdly . But this is short term relief I know 

the flex bar also seemed to help at first but only temporarily . The "stab" continues to be there during the bent arm stuff I mentioned and the "burn" during the straight arm stuff I mentioned 

not sure if you can make any sense of this but really appreciate your thoughts . 

Above all I know to take things slow and cautiously which  I will continue to do but it would be great to actually have a diagnosis so I can really get the right things in place to help heal it.

16 hours ago, Leigh Kettle said:

That said however the following things are the exceptions 

1. sustained holds in the straight arm position can aggravate it as soon as I release the straight arm hold . For example more than around 10 reps of Scap shrugs can start to "burn" deep inside the elbow especially  when i release it as it returns to its deloaded state . Short handstands are ok but I darent do long ones as im certain this will aggravate as it has done in the past . 

2. when my arms are bent for long periods ie on the phone when I straighten them they feel stiff and a little sore 

3.!when I bend my arm quickly to fully bent  (like in snapping motion ) I get a short sharp stabbing pain within the elbows.

At rest there is no pain, when I lift things bent arms that can hurt as can doing things like putting my hands behind my head and interlocking the fingers as this puts my elbows in full flexion, always like a short sharp stab

surprisingly to me the only thing that seems to make my elbows feel normal and "healthy" despite  all of the massage work and that I've had is a rub of the anti inflammatory gel voltarol .i felt a bit of pain  more than usual a couple of weeks ago so I just rubbed it in see if it helped and it did weirdly . But this is short term relief I know 

- Provided you are getting sharp pain deep in the elbow this hints at ligament/tendon damage. I would get the same symptoms. Very sharp pain in the medial elbow when doing certain movements (Cooking, cutting veggies, straight arm work, passive hanging, going into end ranges of wrist flexion). It would come on slow then increase with intensity if I tried to persevere. 

wether it is actually tendonitis is hard to say. Could very well be ligament damage around the elbow joint itself. 

These were my symptoms when my arms were chronically flared (both elbows were hurt)

- Burning radiating all the way from the inside elbow pit down in to the wrist sometime hands. 

- Sharp pain in the elbow 

Also note flare ups would come at random times when I was at rest. 

My advice

1) consider getting a MRI if you want a visual on the tissue in your elbow. This will help pinpoint the problem. 

2) Continue to take it easy as your doing. Avoid straight arm work, and focus more on getting fresh blood into the effected area more than anything. Ligaments and tendons take obnoxiously long to heal as their blood supply is limited, especially in the elbow pit. Your bent arm work is probably fine if it doesn't continually aggravate it. 

3) add in some higher volume curls and tricep extensions, and forearm work to really promote blood flow. Keep it around 12-20 rps and avoid failure. 

Do any of your symptoms match with mine? Also do you get any radiating pain going down your arm? 

Also look and see if their is a MAT (Muscle Activation Therapist) near you. May or may not be one, they are mostly in the U.S and Canada

@Leigh Kettle just out of curiosity, do you have hyperextending elbows? If your joints easily go into hyperextension it might put too much stress on the joint when doing straight arm work.

5 hours ago, Ryan Segervall said:

- Provided you are getting sharp pain deep in the elbow this hints at ligament/tendon damage. I would get the same symptoms. Very sharp pain in the medial elbow when doing certain movements (Cooking, cutting veggies, straight arm work, passive hanging, going into end ranges of wrist flexion). It would come on slow then increase with intensity if I tried to persevere. 

wether it is actually tendonitis is hard to say. Could very well be ligament damage around the elbow joint itself. 

These were my symptoms when my arms were chronically flared (both elbows were hurt)

- Burning radiating all the way from the inside elbow pit down in to the wrist sometime hands. 

- Sharp pain in the elbow 

Also note flare ups would come at random times when I was at rest. 

 

My advice

1) consider getting a MRI if you want a visual on the tissue in your elbow. This will help pinpoint the problem. 

2) Continue to take it easy as your doing. Avoid straight arm work, and focus more on getting fresh blood into the effected area more than anything. Ligaments and tendons take obnoxiously long to heal as their blood supply is limited, especially in the elbow pit. Your bent arm work is probably fine if it doesn't continually aggravate it. 

3) add in some higher volume curls and tricep extensions, and forearm work to really promote blood flow. Keep it around 12-20 rps and avoid failure. 

 

 

Do any of your symptoms match with mine? Also do you get any radiating pain going down your arm? 

 

Also look and see if their is a MAT (Muscle Activation Therapist) near you. May or may not be one, they are mostly in the U.S and Canada

Hey ryan

thank you so much for such a detailed response I really appreciate it 

I don't think my symptons are like yours in the most part . I've never experienced the pain radiating down the arm that you mention.!! It's Always concentrated in the elbows ,tho  my forearms are usually quite tender to the touch tho as they near to the elbow.

 general day to day things are ok apart from the few things I mentioned ....and I've never had sharp pains come whilst resting...

i will definitely incorporate the exercises you mentioned so thank you 

just to clarify ; 

should I be performing both the concentric and eccentric phase of the curls you mentioned and with what kind of weight would you recommend as I've read eccentrics should be quite  heavy but if you saying to do full curl should this be light ?

i don't seem to be able to find a muscle activation therapist . I am seeing my doc tomorrow with a letter from my osteopath regarding obtaining an mri so this is my next step 

thank you once again ryan

shame we don't live nearer so we could get together that would have been great for us both 

Leigh 

4 hours ago, Benjamin Renaud said:

@Leigh Kettle just out of curiosity, do you have hyperextending elbows? If your joints easily go into hyperextension it might put too much stress on the joint when doing straight arm work.

Hey benjamin

yes I do have elbows that hyper extend somewhat and it is something I've often thought about when I used to train tuck planches etc in the past . The "de load" from these when I used to do them would create this burning sensation as I released from the straight arm . 

. I'll attach a pic below to show you to what extent I hyper extend

kind regards

leigh. 

Benjamin,

Here is my right arm both supine and prone ......

9 minutes ago, Leigh Kettle said:

just to clarify ; 

should I be performing both the concentric and eccentric phase of the curls you mentioned and with what kind of weight would you recommend as I've read eccentrics should be quite  heavy but if you saying to do full curl should this be light ?

i don't seem to be able to find a muscle activation therapist . I am seeing my doc tomorrow with a letter from my osteopath regarding obtaining an mri so this is my next step 

 

- For the Bicep Curls I would start with a neutral grip at first you can do the concentric phase if it feels okay. If you get sharp pain during the concentric I would stick to just the ecc. portion of the curl for about 6 weeks. then start bringing the conc. back in. If doing the full rep you want to go slow up and slow on the way down. I would follow the tempo of 2 seconds up and 3-5 seconds down. Start with a weight that allows all of this to be pain free. It might be light as 5lbs or as heavy as 20lbs, I recommend starting light and creeping your way up. If you start TO HEAVY your going to do more harm than good, if you start TO LIGHT theres no risk involved. Keep the reps in the 12-20 range for 2 - 4 sets. Start with 2 and see how it goes, if its comfy with to symptoms then next session increase the volume to three sets and so on. 

- Same goes for tricep extensions. 

- Some forearm exercises you can do would be wrist flexion/extension/supination/pronation

- You can do the concentric phases if its not eliciting pain. again following the slow tempo of 2 up and 3-5s on the way down. Rep ranges would be 10-20, and start light. I would start with 2-3lbs and see how it goes. if its stupid easy and you have to symptoms you can graduate to 5lbs and again see how it goes. Progress slow and safely, last thing you want is to make to big of a jump and then have that be too much. 

A sample finisher you could put at the end of your foundation training could look something like this 

* No rest in between A1 and A2, w/ 30s rest after A2. Do this for rounds

( elbow flexion/extension 2-4 rounds, 12- 20 reps) 

Tempo : 2s up 3-5s down

A1. Neutral Bicep Curls

A2. Skull Crusher

(Wrist work 2-4 sets 10-20 reps) 

Tempo : 2s up 3-5s down

* note I just alternate between hands for rest. Ex// for B1 i would do say 10 wrist curls on left arm then do 10 wrist curls on my right then back to the left. So on and so forth until I've done the set volume for that exercise, then move onto C1. 

B1. Wrist Flexion 

C1. Wrist Extension 

D1. Wrist Supination/Pronation 

@Leigh Kettle also I you need some footage of these exercises I can film some videos tomorrow during my training session 

@Leigh Kettle Also looks like you got a good amount of hyper extension in those elbows. I would take this up with your doc and see what he has to say about straight arm work. Hyperextended elbows is going to make the loads on the elbow joint greater than non hyper extended elbows when doing straight arm work. 

- I would avoid it now for sure. Give the tissue a chance heal, but see what the doc has to say. 

13 hours ago, Ryan Segervall said:

@Leigh Kettle Also looks like you got a good amount of hyper extension in those elbows. I would take this up with your doc and see what he has to say about straight arm work. Hyperextended elbows is going to make the loads on the elbow joint greater than non hyper extended elbows when doing straight arm work. 

- I would avoid it now for sure. Give the tissue a chance heal, but see what the doc has to say. 

 

I've been told in the past that the hyper extension shouldn't be detriment to my straight arm work as i did wonder . It almost feels like I could slightly bend my arm and it would "appear" straight but surely this isn't elbows locked that is so often drummed into us here at gb. I mean should I not be locking out because of my hyper extension ? Be interesting to see what the coaches have to say about this . 

18 minutes ago, Ryan Segervall said:

@Leigh Kettle also I you need some footage of these exercises I can film some videos tomorrow during my training session 

Some videos would be greag Ryan if it's not too much trouble just so I know I'm doing what you are saying correctly 

thanks so much 

21 minutes ago, Ryan Segervall said:

- For the Bicep Curls I would start with a neutral grip at first you can do the concentric phase if it feels okay. If you get sharp pain during the concentric I would stick to just the ecc. portion of the curl for about 6 weeks. then start bringing the conc. back in. If doing the full rep you want to go slow up and slow on the way down. I would follow the tempo of 2 seconds up and 3-5 seconds down. Start with a weight that allows all of this to be pain free. It might be light as 5lbs or as heavy as 20lbs, I recommend starting light and creeping your way up. If you start TO HEAVY your going to do more harm than good, if you start TO LIGHT theres no risk involved. Keep the reps in the 12-20 range for 2 - 4 sets. Start with 2 and see how it goes, if its comfy with to symptoms then next session increase the volume to three sets and so on. 

 

- Same goes for tricep extensions. 

 

- Some forearm exercises you can do would be wrist flexion/extension/supination/pronation

- You can do the concentric phases if its not eliciting pain. again following the slow tempo of 2 up and 3-5s on the way down. Rep ranges would be 10-20, and start light. I would start with 2-3lbs and see how it goes. if its stupid easy and you have to symptoms you can graduate to 5lbs and again see how it goes. Progress slow and safely, last thing you want is to make to big of a jump and then have that be too much. 

 

A sample finisher you could put at the end of your foundation training could look something like this 

* No rest in between A1 and A2, w/ 30s rest after A2. Do this for rounds

( elbow flexion/extension 2-4 rounds, 12- 20 reps) 

Tempo : 2s up 3-5s down

A1. Neutral Bicep Curls

A2. Skull Crusher

 

 

(Wrist work 2-4 sets 10-20 reps) 

Tempo : 2s up 3-5s down

* note I just alternate between hands for rest. Ex// for B1 i would do say 10 wrist curls on left arm then do 10 wrist curls on my right then back to the left. So on and so forth until I've done the set volume for that exercise, then move onto C1. 

B1. Wrist Flexion 

C1. Wrist Extension 

D1. Wrist Supination/Pronation 

This is awesome Ryan . I can't thank you enough for this. 

I will experiment with all of the above and see what comes of it . 

Like you say if it is ligaments I can understand why it's taking so long to heal with such poor blood supply in this area . It's such a major issue when almost everything goes through the elbows that when there is a problem it can affect so many different things 

I wouldn't wish what me and more so you with the kind of thing you've experienced upon anyone . Not being able to give gst our all from the beginning is just so depressing especially when healing times are so slow 

@Leigh Kettlemake sure you check with the online coaches here about hyperextension and how to deal with it. From what you describe, you don't have epicondylitis. My intuition (for what its worth) is that somewhere the ligaments (and not tendons) are getting too much load, but I'm no expert by any means. I just love to read training and anatomy books. I've also had my share of injuries that I've mostly had to self treat due to lack of good physical therapist here in the small town where I live.

@Leigh Kettle @Benjamin Renaud

I agree with Benjamin with it being more of a ligament issue than tendon. 

I discussed this with several of the Physical Therapist that I work with and they had some advice on how to deal with ligament issues. 

1) off load the joint. Its take about 6-8 weeks for ligamnets to begin scaring up and filling in the tears that have occured. 

2) reintroduce light strength work targeting joints above and below the affected joint to restor stability. 

This would comprise of the bicep tricep work & the wrist work that I mentioned previously. I would also add in some rotator cuff work to further stabalize the shoulder. I would recommend face pulls as an exercise of choice. 

3) gradually increase resistance over time and after about another 6-8 weeks of lighter work begin creeping into the lower rep ranges (10 and below) 

Hope this is helpful. 

And Leigh ill film a couple sets for you tomorrow 

This might also be useless, but after reading on Mark's daily apple about collagen, I started supplementing with some. Seems that although your body does produce some, as we age (I might be older than you guys) we produce less than what we need. We need 7g per day +/- and only make about 2g the rest coming from our diet. If you have a great diet including cheap meat cuts, bone broth and eat the cartilage and skin from the meats you prepare then you might not need supplements but I take some just in case. I take powdered version, not capsules or liquid forms, its cheaper and you can take as much or as little as you want.

@Benjamin Renaud

collagen suppliment is also a great idea. Not a merricle pill by any means but will certainly aid in the recovery process. 

I supplimnet with great lakes grass fed beef collagen. Worth the investment in my opinion. 

Also for clarity im only 21 going on 22 this month but have had an unhealthy amount of injuries from skiing and other sports in my short 21 years. I am studying kinesiology at College and am currently Pre Physical Therapy. Ive certainly learned a ton over the past years from my classes, medical proffesionals, gb, and other valid online sources.  I am decades away from being an expert at this point, but one day I will be  

9 hours ago, Benjamin Renaud said:

@Leigh Kettlemake sure you check with the online coaches here about hyperextension and how to deal with it. From what you describe, you don't have epicondylitis. My intuition (for what its worth) is that somewhere the ligaments (and not tendons) are getting too much load, but I'm no expert by any means. I just love to read training and anatomy books. I've also had my share of injuries that I've mostly had to self treat due to lack of good physical therapist here in the small town where I live.

Th and benjamin

i will start a post asking for advice on this matter 

thank you once again I know the struggle with finding specialists as i too live in a small town

leigh 

8 hours ago, Ryan Segervall said:

@Leigh Kettle @Benjamin Renaud

 

I agree with Benjamin with it being more of a ligament issue than tendon. 

 

I discussed this with several of the Physical Therapist that I work with and they had some advice on how to deal with ligament issues. 

1) off load the joint. Its take about 6-8 weeks for ligamnets to begin scaring up and filling in the tears that have occured. 

2) reintroduce light strength work targeting joints above and below the affected joint to restor stability. 

This would comprise of the bicep tricep work & the wrist work that I mentioned previously. I would also add in some rotator cuff work to further stabalize the shoulder. I would recommend face pulls as an exercise of choice. 

3) gradually increase resistance over time and after about another 6-8 weeks of lighter work begin creeping into the lower rep ranges (10 and below) 

 

Hope this is helpful. 

And Leigh ill film a couple sets for you tomorrow 

 

 

Ryan 

by off loading the joint do you mean literally not do anything(foundation wise)! with the elbow . Including the bent arm work I mentioned that causes no pain ? 

Hey ryan 

I've had a go at the bicep curls neutral grip and they feel fine doing the concentric so I will continue with this as you suggested using a 2.5kg dumbell which felt fine if not a little light but I'll start here to be safe 

so this is what my session would look like 

Wrist flexion using 2s up 5 second down light Dumbbell X 15 reps (2 rounds both wrists )

Wrist extension using 2s up 5 second down light dumbell X 15 reps (2 rounds both wrists)

Wrist pronation using 2s up 5 second down light dumbell X 15 reps (2 rounds both wrists) 

Wrist supination using 2s up 5 second down light dumbell X 15 reps (2 rounds Both wrists) 

Bicep curls (neutral grip) 

using 2s up 5 second down light dumbell into Skull crusher  using 2s up 5 second down light dumbell rest for 30 seconds then repeat 2 more times 

Does this all seem OK?

3 questions regarding This

Would skull crusher be best using a barbell or is neutral grip dumbell better?

you said before use this as a finisher so would you recommend it be done always after training ?

Would I do this everyday or only training days ?

Thanks once again and sorry for all the questions 

Leigh 

17 hours ago, Leigh Kettle said:

I've been told in the past that the hyper extension shouldn't be detriment to my straight arm work as i did wonder . It almost feels like I could slightly bend my arm and it would "appear" straight but surely this isn't elbows locked that is so often drummed into us here at gb. I mean should I not be locking out because of my hyper extension ? Be interesting to see what the coaches have to say about this . 

 

- It the long run the tissue in your elbow will be able to adapt to straight arm work, as it has done in the past. For now, provided there is damage that needs to be healed, I would avoid it. 

6 hours ago, Leigh Kettle said:

Ryan 

by off loading the joint do you mean literally not do anything(foundation wise)! with the elbow . Including the bent arm work I mentioned that causes no pain ? 

 

- I think you are past the stage of not doing anything, but certainly keep it very light. If you apply big loads to the elbow, such as straight arm work or more advanced bent arm work you are asking for delayed recover and chance of this acute injury going chronic. Gotta scale it back big time. I would say PE 1 or 2 for all bent arm work for the next 4-8 weeks

- also it depends what the MRI says. I recommend playing it safe until you get a visual on the severity of the situation

3 hours ago, Leigh Kettle said:

 

Hey ryan 

I've had a go at the bicep curls neutral grip and they feel fine doing the concentric so I will continue with this as you suggested using a 2.5kg dumbell which felt fine if not a little light but I'll start here to be safe 

so this is what my session would look like 

 

Wrist flexion using 2s up 5 second down light Dumbbell X 15 reps (2 rounds both wrists )

Wrist extension using 2s up 5 second down light dumbell X 15 reps (2 rounds both wrists)

Wrist pronation using 2s up 5 second down light dumbell X 15 reps (2 rounds both wrists) 

Wrist supination using 2s up 5 second down light dumbell X 15 reps (2 rounds Both wrists) 

 

Bicep curls (neutral grip) 

using 2s up 5 second down light dumbell into Skull crusher  using 2s up 5 second down light dumbell rest for 30 seconds then repeat 2 more times 

 

Does this all seem OK?

 

- Looks good to me!

3 hours ago, Leigh Kettle said:

 

3 questions regarding This

 

Would skull crusher be best using a barbell or is neutral grip dumbell better?

 

y

- I would do dumbbells in a neutral grip

I would do something similar to the first half of this video ( up untill 2:17 min) for the triceps, and even biceps if you want. Start light 

3 hours ago, Leigh Kettle said:

 

you said before use this as a finisher so would you recommend it be done always after training ?

 

- ya do this after training. Or for now you could even do as a stand alone workout and stop doing Foundations work for the mean time until things get better. Kinda depends on how things feel. If you get the slightest hint from your elbows that the foundations work might be too much at the moment then I would dump it. If it seems fine with NO sharp pain during then your fine. (Sharp pain = re-tearing) 

3 hours ago, Leigh Kettle said:

 

Would I do this everyday or only training days ?

 

- Just on training days 2-4days per week. with at least a day 

2 day split : M TH

3 day Split : MWF

4 day split: M W F Sun // Tue THu Sat // Mon W F Sun ect.