Elbow pain advice

On 8/11/2017 at 4:31 AM, Garry Barker said:

I'm a bit all over with the rehab (I have to wait 6 weeks to get an appointment with a  physical therapist) so it's good to have a plan to work with. Will give this 100% 

Thanks for taking the time to write down advice @Ryan Segervall and @Nick Murray I know it's not the most exciting topic but probably one on the most frustrating! They flared up again after only biking 2 miles to work.

Ryan I don't suppose you know of any good Youtube videos for the Phase one isometrics (1-2 weeks) to follow?

Did you find heat and/or ice treatment effective?

- Garry I would recommend making hot cold showers part of your daily routine. They can really help keep inflammation under control along with a whole host of benefits. I like to do 20s cold 20s hot for 10 rounds. 

Thing to note, is that heat and cold are modalities and will not "fix" you per say, they are about 10% of the equation and can help facilitate quicker healing BUT in order to stimulate new tissue to be played down in an organized manner we need to apply load to the joint/tissues. 

these can be a great start, but may be to intense. try them out but if they flare you up I would recommend regressing the intensity 

 regression^ put your wrist in end range of motion and then push against your other hand for time. I would do this in all the wrist positions shown in the video above. 

6s is a good time for these isometrics. 

sorry it took me so long to get back to you. Let me know if you have any questions!

Thanks @Ryan Segervall

Great link. I've been putting the isometrics in like you advised and it feels good.

Just been reading through your other topic with @Leigh Kettle There is a lot of great advice in there although i also realised I have a long journey ahead. It's frustrating knowing the length of time that this could possible take but encouraging to read that others have had the same or similar issues but recovered and are able to start on PE1's again pain free.

How are you eblows currently, are you both fully recovered fully now?

@Garry Barker

I am 100% recovered now but my case was a bit special because my elbows were miss diagnosed and mis treated for a year & a half before I even started getting on a proper rehab program. Mine was suuuupper suuper chronic & was hypersensitive to just about anything. Unloading a dishwasher would set it off and cause me to have to go lay down for 20 min before it subsided. So it obviously took longer (8months) than it normally would have with someone who had just started experiencing symptoms (under 4 months. The faster you git on a good rehab protocol the faster you'll get better. 

And this doesnt mean you have to stop working out al together for those 4 months. We just need to be extra cautious with the loads placed on your elbow for the next little bit as that tendon remodels.  

Can you please give me a brief synopsis of what aggravates your elbows (daily tasks, GST PE's, ect.), and throughout the day how often and how much pain are you in. 

Id stick with isometrics for the next 2 weeks, then we can probably add in some eccentrics with a therabar. (https://www.amazon.com/TheraBand-Resistance-Epicondylitis-Tendonitis-Intermediate/dp/B01N7KI8N9/ref=sr_1_1?ie=UTF8&qid=1502977167&sr=8-1&keywords=therabar+flexbar) 

Hey Garry the ice /heat protocol can be useful to reduce the swelling and improve the blood flow when the injury occurred. 

How much the protocol works depend on the body part, there are some places where the vascularization it is always reduced.

Unfortunately i think i missed the important part with the icing due to not realising the seriousness of the injury. 

When I first felt it during a table climb and ground rows so I dropped the both but continued with everything else now realising i made it a lot worse.

Basically everything I pick up has to be elbows tucked in to the sides and what ever I'm picking up has to be close to my chest e.g my daughter down to the kettle or when washing the pots I can't put to much pressure on.

I can get away with straight arm (SPLPE3) but no other upper body

I have a appointment next week which I have had to wait 6 weeks for so hopefully they will allow me to have some sort of scan but I know the chance of that's really slim

@Garry Barker Hang in there I know the feeling. Let me know what the therapist's say, id recommend staying away from anything that aggravates it. Try to keep consistent with what you can do w/ core & mobility that doesnt aggravate it. 

@Ryan Segervall To be honest I think I will probably have better advice from the this thread and your previous one i'm just hoping for the scan really, but if there if there is anything I think is helpful I will be sure to post.

Glad to know you are 100% recovered I can see it been a long journey for you. And it's good of you to pass on the information as well.

Hey garry

sorry to hear of your elbow trouble

i too have experience with this tho not golfers or tennis but elbow issues all the same 

ryan gave me some brilliant exercises to do so I can vouch strongly for eccentric loading and throwing in some rice bucket work at least 2 times a week to really get the blood flowing into that area . Working those muscles around the elbow is the way to get that much needed fresh blood to promote the healing of them

as I say this has been working great for me and from what you've described I'd say I was in a worse starting position so I'd highly recommended you include this 

good luck and keep us posted on your recovery and progress 

leigh 

Hi @Leigh Kettle

I read through the other thread with you and Ryan and got some great info form it. I can't imagine how frustrating it was for you having a unheard of elbow injury it's bad enough with this one. 

Hopefully I will be qualify for a scan least then I know what I'm working with 

Thank for the input. will and rice into the mix as well

@Garry Barker

Hey Garry how have your symptoms been after adding in the prescribed exercises?

Hi @Ryan Segervall

I've had massive improvements no standing pain  or tenderness just slight pulling with the hammer curls.

I had a appointment at the musculoskeletal centre and he said I was doing everything right but just need to up the stretches which I have done and continue rehab after the pain has gone. So your advice was spot on!

I think the novel movements video you sent have worked wonders. I will continue on with these afterwards...

A positive is that I  had stiff wrists which have now starting to loosen off due to all the stretching so now looking forward to getting onto planche leans in the future which I was a bit concerned about before

I noticed we started GST an just about the same time and have suffered similar injury so will be good to see where we are a year from now.

Thanks Again Ryan

@Garry Barker 

So glad to here things are getting better! Yes keep up with the novel movements, I do those before every H1 and upper body session. Novel movements will help a ton with increasing active range of motion and will make straight arm work and handstands that much safer for your wrists. 

I would still pump the breaks a bit on returning to straight arm work for now. Give it a month. Next move is to order yourself a therabar ( Id recommend starting with red https://www.amazon.com/TheraBand-Resistance-Epicondylitis-Tendonitis-Tendinitis/dp/B00067E4YU/ref=pd_sim_328_4?_encoding=UTF8&refRID=8HQ6DF34H2MWC6NT8N1V&th=1) 

I like the therabar over dumbbells because you get a relatively constant torque across the wrist joint where as with a dumbbell when you in full wrist flexion the torque is almost zero and maxes you when your wrist is in neutral. Therabars worked wonders for me, and ive tried just about everything, highly recommend). 

Start therabar work next week 3-4 days a week. Preform novel wrist movements as a warm up. 

Id recommend using the following progression scheme (but keep in mind sometimes you will need to spend an extra week at a specific volume before progressing) 

week 1: 2x10r

week2: 2x15

week3: 3x12

week4: 3x15

week5: Upgrade to a heavier bar

Any questions let me know!

Hi @Ryan Segervall

Had to lay some slabs yesterday and had a flare up today. Calmed down again quickly but a sharp reminder that there is still a long way to go.

Have ordered a Therabar so looking forward to getting started on that using your progressions 

On 8/25/2017 at 7:06 PM, Ryan Segervall said:

Novel movements will help a ton with increasing active range of motion and will make straight arm work and handstands that much safer for your wrists. 

Looking at the positives though, i'm now enjoying the new ROM from the stretches, pretty sure I wouldn't have this is I didn't get this injury in the first place.

Good post in the ''building strength'' topic btw

@Garry Barker Flare ups are going to happen, its the nature of the beast. doing a cold hot cycle or doing doing a bunch of elbow circles for time (up to 5 min) and going through the wrist mobility I gave you can help flush out the tissue and calm things down. But when its really flared up best to just try not to further aggravate it. If it makes it worse then dont do it. Play around and see if these help

On 8/26/2017 at 1:46 PM, Garry Barker said:

Good post in the ''building strength'' topic btw

 

thank you! 

@Garry Barker 

Hey, how have things been progressing? 

Hi @Ryan Segervall

Hope you are good.

Making good progression sticking to your advice, moved up to a heavier hammer and the next therabar next week. Still get some flare ups from certain things but it a different feeling now hard to explain really. All good with everyday activity's, skipping and straight arm plank holds now though.

When did you get back into your pushing, was it only when you were completely pain free, did you have any flare up at all afterwards? I was going to wait till after the next weight hammer and 3rd theraband so it strong enough.

On 9/12/2017 at 0:14 PM, Garry Barker said:

Hi @Ryan Segervall

Hope you are good.

Making good progression sticking to your advice, moved up to a heavier hammer and the next therabar next week. Still get some flare ups from certain things but it a different feeling now hard to explain really. All good with everyday activity's, skipping and straight arm plank holds now though.

When did you get back into your pushing, was it only when you were completely pain free, did you have any flare up at all afterwards? I was going to wait till after the next weight hammer and 3rd theraband so it strong enough.

 

 

awesome to hear things are progressing! If I were you I would start with some dumbbell works for your bent arm strength. The loads are a lot easier to control and are safer to start out with. 

Begin adding in some dumbbell bench press and a rowing variation to supplement you bent arm GST work for now.  I would say keep the reps around 8-12 reps and bump up the load 5-10% every other week for about a month or two. Load = reps x sets x weight.

Also adding in some slow controlled bicep hammer curls and tricep extensions can work wonders. I would say follow a tempo of 2s up 2s down, for about 10 reps. you can super set them resting about 1 min in between sets.  

Sensations after your workout shout primarily be muscle fatigue and blood pump. But there will be some flare ups now and then but should be minor compared to when things are really bad. I like to say keep it below  4/10 discomfort on the discomfort scale. 

And for me, again, not really a good comparison because I was in pain for much longer (2 years) before I got on the right track. It took me 8months to get back to straight arm work SPL PE1 and about 5 months to get to doing incline pushups. You will not have to wait that long i am certain. 

Let me know if you have any questions, happy to write this out into a program if you need

Will give it another week or so and move onto those with empty bars to start with just to make sure

My ''3 week off'' has become a more realistic 3 month so looking forward to getting back to the PE1's.

I noticed you on the HBPPE2.  Good to see that eventually you can get back there with the right effort and advice!

6 hours ago, Garry Barker said:

Will give it another week or so and move onto those with empty bars to start with just to make sure

My ''3 week off'' has become a more realistic 3 month so looking forward to getting back to the PE1's.

I noticed you on the HBPPE2.  Good to see that eventually you can get back there with the right effort and advice!

@Garry Barker Patience  is the name of the game with this type of injury. You'll get back no doubt, just gotta keep putting in consistent effort!

On 18/08/2017 at 7:56 PM, Leigh Kettle said:

Hey garry

sorry to hear of your elbow trouble

i too have experience with this tho not golfers or tennis but elbow issues all the same 

ryan gave me some brilliant exercises to do so I can vouch strongly for eccentric loading and throwing in some rice bucket work at least 2 times a week to really get the blood flowing into that area . Working those muscles around the elbow is the way to get that much needed fresh blood to promote the healing of them

as I say this has been working great for me and from what you've described I'd say I was in a worse starting position so I'd highly recommended you include this 

good luck and keep us posted on your recovery and progress 

leigh 

Hi @Leigh Kettle

Could you post a link to the thread you reference as I can't find it?

Many thanks

Greg

14 hours ago, Greg White said:

Hi @Leigh Kettle

Could you post a link to the thread you reference as I can't find it?

Many thanks

Greg

Please ignore, I found the post. 

Heh greg

sorry I didn't respond ....there seems to be issues I've mentioned before in that I am no longer getting email notifications advising me of posts and when I'm  tagged etc 

glad you found what you looking for and always here if you need me 

So I eventually got back onto pushing yesterday after 3 months or so. Had a bit of aching this morning in the elbows but don't think this is anything to worry to much about.  Thanks to everyone for the help and advice especially Ryan. I would recommend anyone with similar issues to read through the two topics and take his advice, he knows what he is talking about. 

Just thought I would note some positives down that can be take from having this injury in case anyone is at the beginning stages 

1. Recovery from over training - I kept telling myself to take a month off all training (my recovery time was really slow as well as other issues)  so I could fully recover from years of over training but never did. This injury forced me to have 3 months off but now I feel completely recovered and 100% better all round. I think sometimes your body will find a way of making you give it the rest it needs.

2. wrist flexibility -  I had no wrist flexibility at all and know i would have struggled with planche leans but this has now improved massively due to the 3/4 times a day stretching. I know this is something I wouldn't have focused on before.

3. Understanding Connective tissue - I listened and read about connective tissue and thought I understood but i took me to experience this type of injury for me to give it the real respect it deserves. I though I was taking things slow but now realise I was still rushing to get to the next stages. I think it's difficult to appreciate CT until you have to spend a long time rehabbing an injury.

4. Mobility improvement - SPL mobility was one that I could continue with and have really focused on, repeating all the stages so have now just about completed all stages. I couldn't grip the horse so they feel a lot easier now i can.

5. Stretching - I replaced my training with Middle splits and it woke my up to how seized I actually am. Again this is probably something I wouldn't have done without the injury.

6. Slowing down - The fear of another injury has really slowed me down and I think about form and how it feels during the exercise now instead of reps.

I probably wasted 2 weeks sulking before I started doing something about it and chanced my mind set so get on it straight away. Recovery was just over 3 months but has probably cost me another year on top of that to get back on form. 

It feels great getting back to training because you never think you will get there but I think you will come out the other side with a lot better mindset.

For future reference and for interest: http://semrc.blogs.latrobe.edu.au/10-things-not-to-do-if-you-have-lower-limb-tendon-pain/

Also, look up pretty much everything written by Jill Cook, Craig Purdam and Ebonie Rio. They're world-class researchers in the field of tendonopathies.

(The following is copied from http://pride.physio/pride-physiotherapy-tendinopathy/ It summarises current thinking on lower-limb tendonopathies and should guide treatment of upper-limb tendonopathies. I've highlighted the information relevant to me as a clinician and to others in terms of management or self-management.)

Summary of Jill Cook and Prof Karim Khan’s recent presentation of the paper ‘Pathological tendons maintain sufficient aligned fibrillar structure on ultrasound tissue characterization (UTC)’ Docking SI, Cook J. Scand J Med Sci Sports. 2015 Jun 9. doi: 10.1111/sms.12491.

• Tendinopathic tissue is disorganised; likened to the hole in a donut. The hole in the donut analogy simply reflects an area of altered tissue in the tendon – there are no holes!
• The volume of healthy normal tissue remains the same
• An ingrowth of nerves and blood vessels (seen on imaging) is inconsequential and not correlated with pain
• Strategies intended to alter the pathological tissue are ineffective; pathological tissue does not change. We treat the donut [the normal tissue] not the hole
• Anything intended to kick-start a healing process or re-model tissue is ineffective and misguided
• The tendon as a structure is not weak; it has the same amount of good-quality, normal tissue
• Tenocytes (tendon cells) thrive on load; prolonged rest periods are really unhelpful
• Management should be aimed at increasing the load capacity of the normal tissue to make it more robust; not ‘fixing’ or correcting the damaged part
• If we’re aiming to improve the healthy tissue:
– Massage techniques (cross fiber frictions etc.) aren’t helpful. “feeling better” afterwards doesn’t fix anything.
– Using tools to poke, scrap or “break things up”, isn’t helpful
– Injections aren’t helpful
– Stretching isn’t helpful
• Extremely uncomfortable techniques which create a ton of pain trigger the release of endorphins which temporarily desensitise an area but does nothing to fix the damaged tissue or improve the healthy tissue
• These tendons have too much blood flow (due to the increase in blood vessels) so increasing blood flow is not a concern
• Stretching and compression cause irritation i.e. applying heavy eccentric loads (Alfredson protocol) doesn’t fit the model of avoiding stretching and compression when the ankle is in dorsiflexion.
• Loading should be done in a position of comfort; i.e. avoiding the heel drop off a step.

Again, this is CURRENT thinking; advice and management techniques can, and probably will, change in future.

Edit: This paper states that we cannot rule out inflammation as a component of tendonopathy (the researchers mentioned above generally hold the view that tendon degeneration doesn't involve inflammation). So there are different views on what is going on with a sore tendon, and it will be a long time before a full understanding is reached.

@Garry Barker So pleased to hear you are doing better! Glad I was of help and welcome back to training my friend