Another one joins the tendonitis club:)

[Adriano Katkic]

So my left elbow hurts from doing tucked BL back from Wednesday. I was doing my regular SSC BL work, but I had a few holiday days off beforehand. Seems that jumping back to training with both feet in wasn't such a brilliant idea. The pain is not particularly strong or limiting movements of my left arm, but I assume that the best thing to do would be back off BL work. Which exercises should I avoid? Should I stick to German hangs or tuck BL or do nothing in that plane of motion? Are other statics safe to do? What rehab to do? Anything with chest expanders? Thanks in advance for Your answers!

[Alessandro Mainente]

see in this forum for the post wich are talking about inner elbow pain, bicep tendon conditioning, elbow tendonitis...i'm sure that you can find what you are searching for..

[Joshua Naterman]

Something that I am discovering is that hypertonicity and actual trigger points can be the root cause of the tendonitis.

This may only apply to people like me who have just really had a beating on their bodies and trained beyond their limits too often in the past. However, I have been doing deep work on my forearm muscles and my upper arm as well with my lacrosse ball. I can now hold a pretty good flat tuck BL with no tension, and my planche leans have improved AND feel better. This isn't going to work for everyone, I mean you really can just plain overwork your connective tissue, but for people like me who have done an awful lot of pretty consistent strength training many times the problem is coming from muscle tissue that has learned to be tighter than normal. That's called hypertonicity.

You can have trigger points too, which are localized permanent contractions, but many times hypertonicity is a serious issue. If your muscles are tight you are going to have an artificially limited range of motion and larger applied forces at the end of the range, which is where straight arm work is done. By performing some temporarily painful self-massage on the forearms and upper arms you can train your muscles to lengthen again. This removes a ton of unnecessary stress from the joints and reduces the risk of straining the tendon or muscle tissues.

So var I have found that massaging one side of the joint (wrist flexors, for example) at various levels of stretch (totally relaxed, point of beginning tension, moderate tension) muscle by muscle allows me to do some pretty good retraining of the muscle length. After those levels of massage I then really stretch, holding the stretch for a good 20-30s for 3-4 sets. That's just to get the tissue used to the "new" ROM. You have to do this every day at first, but after a few weeks you can just do maintenance massage once a week or perhaps just the stretching that is part of the wrist routine will be enough.

You can not stretch away many of these issues, the manual intervention is often necessary if this is the problem.

Because of the somewhat sudden and low-key nature of your symptoms during a SSC I am thinking that your muscles may just be too tight. Massaging and then stretching as I have described, section by section from the lower arm to the upper arm will make a huge difference for you if this is part of the problem.

[Cole Dano]

Slizz it great that you have found the MF TP work to be helping.

There is no doubt in my mind that Myofacial Trigger Point release work is an essential part of our regular maintenance.

Thankfully the forearms are one of the easiest places to self massage. Use of a hard ball like a Lacrosse ball, or a wooden dowel to roll against are good. In fact, i'm using the arm of my desk chair.

I just went to my Napropath, and he did some nice release work on my left side. The difference was unbelievable. I don't know why but the results having a skilled body worker massage me much greater. Maybe its just the difference between a few minutes of self massage and an hour of a paid session. However self massage is effective.

Slizz, I think that part of its being so effective for you is that you have already been doing so many other prehab protocols, and this was the missing link.

As usual i'm coming to the forum from the exact opposite side of the spectrum. I learned MFTP works years back, and that and stretching were all i did. When i added the other prehab work learned primarily from Coach Sommer, i began to see more meaningful results.

Rehab wise, resisted supination / pronation exercises, and straight arm wrist roller work are a couple of good options. Tennis/Golfers elbow are fairly common issues, so you can find lots of info online.

[Adriano Katkic]

Yes, I'm aware of lots of good info available on the Internet and this forum, but the problem is I don't have Internet connection available right now, so getting Internet access is kind of an effort now. I logged few minutes ago and have to leave now. Just thought it would be more time saving if I had all the answers in one place. No matter, thanks for your time and answers.

I should mention, though, that I have always been fairly flexible as I am taking stretching seriously since my first workout ever.

[Razz]

I 100% Agree with you Sliz. Whenever I feel tendonitis symptoms coming all I need is a massage and it's gone. And I'm still young and haven't been beating on my body for that many years

[Adriano Katkic]

Is it possible that this is not tendonitis? If I understood correctly, tendonitis takes time to develop; putting stress regularly on aggravated tendon. I was doing my regular SSC workout, nothing my body isn't already used to. Could it be a sprain or something?

In both cases, how would that affect my training regime, and by that I mean handstand, L-sit, tuck FL, advanced frog stand and flat tuck BL, as well as dips, push ups, HSPU, pull ups, curls and rows? Are there exercises I should avoid or back of?

Btw, this TP and massaging stuff sounds excellent. I will definitely try it.

[Joshua Naterman]

It is definitely possible. It is also possible that the tightness may be causing tendonitis to build up even though it doesn't appear as though you are doing anything that should cause tendonitis. The extra tension from the "adaptively shortened" muscles can be enough to wreck your tendons.

Cole: You are definitely right. All the other rehab I was doing really couldn't accomplish much because I am just one big mass of trigger points and overly tightened muscles. Now that I am fixing this stuff my strength is going up faster than it "should" be, especially considering that I'm not doing all that much, just scaled down versions of the WODs. As I get my muscles closer to the length and tension that they should be, my mobility work will actually start to get me somewhere! Once I feel like my mobility and muscle tissue quality is ok I'll start back up with the strengthening bits of rehab again, I haven't done so much of that lately because with the other issues I have it just makes things worse. It is strange how the pain moves around as I continue my self care, it is now closer to my acromion process where as before it was 100% in the coracoid process. That is basically gone now, and for the first time in at least two years I actually feel like I can have a normal body again. I forgot what that feels like.

Sometimes you just have to check on yourself to find out what your issues are. Self care is the only affordable way to keep yourself in the condition you need for long term wellness!

[Adriano Katkic]

OK, been reading this: http://www.itendonitis.com/symptoms.html and this sounds nothing like what I've got. No swelling, no stiffness, no fluctuation of pain intensity (at morning or whenever) etc. Nothing. In fact, by today 90% of my elbow pain is gone. All I got now is a feeling of discomfort and minor pain when I keep my arm completely straight or when I dress/undress my jacket. I am now almost sure this is a strain or something like that, not tendonitis. I guess I should just back off any training for another day or two till my elbow feels normal again. Or should I train but take care of proper warm up and perhaps training intensity? Oh, the pressure :x

[Joshua Naterman]

In most cases this is the first tendonitis symptom to develop. Individuals may feel pain in the tendon when it's under pressure.

This would be when your arm is straight. There are a few things this could be: a strained elbow flexor (very likely), tendonitis in an elbow flexor tendon (also fairly likely), beginning biceps tendonitis (this would be in the lower half of your inner elbow, but so are several other muscles and ligaments; certainly possible), or possibly (but a very low likelihood) arthritis. There are probably other things this could be as well, like referred pain from an injury further away from the joint. I have personally seen that with my shoulder.

If you straighten your arm about 2/3 of the way, you will easily be able to locate your biceps tendon. If, with your arm straight, pressing and sliding down the tendon from the bottom of the bicep to where it disappears below other muscles (1-3" further down) causes no pain with light pressure then you may not have biceps tendonitis. If that does cause pain then you should take the injury more seriously.

If you notice the pain is in the top of your elbow then lower arm elbow flexors are most likely the culprits. These are actually a bit more at risk for injury than the biceps as these muscles and their tendons are very small by comparison yet the leverage acting on them is not any better.

Whatever you do, if you still feel pain then you are still injured. To try and start working back into your routine would be foolish if you still feel something when you straighten your arm all the way. You need a combination of comprehensive lower and upper arm heat, massage, and stretching in that order. As far as strength work goes, limited ROM light biceps curls or band pulldowns that cause absolutely no abnormal sensation would also be a good idea, but keep the volume low. You need blood flowing there and heat getting into the muscles and tendons. Those two things need to happen as much as you can arrange, so as an example wearing long sleeves or at least neoprene elbow sleeves to retain heat in the area is a very, very good idea. You can and should move your arms through pain free ROM ONLY. Don't push it. Only do what does not hurt at all. The motion is important, but keep the volume per session low and keep sessions frequent. Doing this once an hour with just your arms for 15-50 pain free reps is a great way to keep blood flowing, along with arm circles if they do not hurt. You need to actively pump blood through the affected areas without creating tension that causes pain, because if you feel pain you are going to be causing unnecessary inflammation.

[John Sapinoso]

I'm having a weird feeling in my lower part of my left bicep too. I don't think it's tendinitis though but I could be wrong.

It's fine when doing nothing, but slightly weaker (not painful) on pulling exercises. I sometimes have mild pain in my lower bicep area and wrist extensors when i flex my arm as hard as i can with my palm facing away from my arm. It also sometimes hurts a little bit in the same areas if my arm is at 90 degrees and i rotate my wrist as far inward (palm facing toward my arm) as possible. This motion used to make my elbow "crack" in the same meaning of the way you "crack" your knuckles, but now it results in mild pain and no crack.

What do you guys think?

[Adriano Katkic]

Ok, I'm totally confused now. I tried what you sad, slizz, and tested the arm to localize the source of the pain. I feel it in a spot, not area. It's next to the top of the elbow on the outer side, like this:

I found that doing various stuff helps the elbow to feel better. Using chest expanders in this position:

and then straightening the arm (done for 15 reps with low/medium resistance every now and then), if I do a pull up or two, even getting in advanced frog position for a second or two; it feels better after I do those stuff.

I feel better today, ALMOST no pain or anything. I just feel that something is not quite right yet.

And don't worry, I didn't train since wednesday, when I hurt my elbow. That comment above was just expressing my frustration with not being able to train right now. I know better then train now and wreck myself. Of course, that cognition came the hard way during my past experiences

[Joshua Naterman]

Ts00nami:

That's what I feel now. I believe that is the brachioradialis that you are feeling. Heat, soft tissue work along the length of the muscle (and everything else in that area too) followed by moderate stretching should help a lot. I do not know if that is technically early tendonitis or just a lightly strained muscle, but either way it is not terribly good. See now the muscle feels. Start with your arm flexed at 90 degrees, forearm resting on a table, and palpate the muscle. Search google images for a picture of where it is if you don't know. When you push the muscle against the bone, along the entire length you should be able to feel individual bundles moving within the muscle belly. That will take some pressure, but it should not hurt. If it hurts, that area will almost certainly be too tight and will need to be massaged and stretched. Same goes if you just feel one unyielding lump instead of a sack full of straws or strings, so to speak. Less likely, but possible, is that you will feel something hard and around the size of a pea or lentil. That is a trigger point. Those have to be either freeze sprayed and then stretched or heated and massaged. I have found that a combination of active and passive techniques is the most useful for all of these situations.

Repeat that same series of palpations along the length of the muscle at 120, 150 and 180 degrees extension. This will help you determine a few things. One, it will help you determine the point at which excess tension is generated, which will tell you how much the muscle has shortened. Two, it will help you determine if there is a point of "binding." Binding is when, despite not being anywhere near full muscle length, there is tension generated in the muscle. You will be able to feel it if you know what you are feeling for. This too has to be massaged, but this is handled somewhat differently. Instead of working on a tight area directly you will run down the entire muscle and will be trying to get under it as well as on top of it. This lets you get at any adhesions in the area and (seems to) helps relax the nervous system. Just don't be too hard.

As far as pressure goes, I have found that I have accomplished much more by simply applying just enough pressure to be able to move through and over the area of tightness without making it jump. I tend to use strokes that go directly parallel with the muscle fibers and also 30-45 degrees off of parallel. That last one is what will make the tight sopt (or the whole muscle if it is just too tight in general) jump if you push too hard. Just enough pressure to steadily grind through the tight spot is all you want. It will feel weird but not horribly painful. If you are pushing hard enough for extreme pain you can cause the area to tighten up further, so that is not advisable. You will be able to steadily increase the pressure as you do more strokes without feeling more pain, and you will feel the muscle yield more. When treating an entire muscle that is tight, my recent experiences are showing me that full muscle strokes and shorter, 1-2" strokes over individual areas, moving slowly up the muscle every 10-20 strokes, is working best for me. Usually I will do 10 shorter strokes up each area of muscle and then 10 very slow, longer strokes that go all the way up in one pass. By very slow, I mean 10-20s sometimes. Sometimes that is how long I have to take for a 1" stroke, especially on my rhomboids.

All the sources I have accessed recommend 6-20 strokes per tight area per treatment. It is advised that you self-treat frequently, up to 8 times a day. Try and remember that what you are REALLY doing is teaching the nervous system to relax. Like any other neural learning, it takes repetition. Because of the high volume, if you use too much pressure you will either bruise or you will develop dry patches of skin. I recommend using some kind of oil, preferably grapeseed but anything will work. Lotion is ok too, but it dries quickly.

All this will do is make sure that you are not developing too much tension at the elbow, this will not get rid of any inflammation you already have. This can and many times does allow tendinitis to fade quickly and prevents it from reoccurring but this won't take the place of fish oil and other anti-inflammatory foods or medication.

I would think that backing off of the straight arm work by a good bit for a few weeks and doing a lot of rehab work with just enough strength stuff to maintain (as long as you don't feel anything during or after) should be ok, but you might just need a week or two of no straight arm stuff at all before starting that small volume of maintenance straight arm work.

Make sure you hit the biceps, triceps and any other referral areas as well, just to make sure you are doing what you can to take care of the problem.

[Cole Dano]

Adriano, this sounds similar to an issue i had.

The program i followed was -

High rep chest expander triceps extensions, and bicep curls (100 reps each)

Wrist roller with straight arms (actually i have this rubber bar from lifeline, does essentially the same thing)(see slizz's video for details if needed)

Straight arm supination and pronation(I used Indian clubs for this, but a length of pvc pipe weighted with sand will do)

[Adriano Katkic]

Thanks, Brady.

Was it tendonitis or something else?

How long did you follow that program before you started BtGB again?

[John Sapinoso]

Good ideas sliz,

A few things I've been doing that might be helpful to you..

Creatively find a way to have to affected arm completely relaxed and somehow apply pressure to various tight areas then with the other arm rotate the wrist and extend the arm away from the point of pressure several times until the muscle relaxes. This usually results in me sandwiching my arm between my legs or my knee and a table and using my other arm to manipulate the rotation and extension of my affected arm.

[Cole Dano]

You could try that with a stretch band hooked to a wall (or door) The band will help your arm release and it would be allot easier to rotate in various ways. I do that type of thing allot, and hit the problem with a massage tool at the same time.

[Joshua Naterman]

Good ideas sliz,

A few things I've been doing that might be helpful to you..

Creatively find a way to have to affected arm completely relaxed and somehow apply pressure to various tight areas then with the other arm rotate the wrist and extend the arm away from the point of pressure several times until the muscle relaxes. This usually results in me sandwiching my arm between my legs or my knee and a table and using my other arm to manipulate the rotation and extension of my affected arm.

I'm having trouble visualizing this one! Any chance of a video in a week or two?

[Stewart Whaley]

Check out the Jan 14 wod video for some examples of immobilizing

the arm with a band:

http://www.mobilitywod.blogspot.com

I think they are at about 5:30 and 6:30. Is used for wrist work here but a similar principle.

[Eddie Stelling]

I am also experiencing some elbow pain. Its on the top/outside of the elbow where the meaty part is. I felt it the most doing a clean, a muscle up, and during an L-sit. The pain is somewhat sharp and goes up the top of my forearm and eventually effects my grip. I have no pain all day and barely feel it when doing my FSP warmup. But when I start the workout it hits me and is sore for about an hour after. I have been resting it and massaging/stretching it. My question is, is there any upper body activity I can do while this is healing? I feel no pain doing handstands, do you think I can do these or is that stupid and I should just rest it entirely?? Also does anyone have any other reccomendations? Thanks alot!

[Joshua Naterman]

You probably need to break up soft tissue restrictions. http://www.drhartman.com/graston_iastm_tools.htm Has a good tool along with how to use it. It's 130 bucks, but that includes instructional dvds from what I understand. That money is about what one or two cash only visits would be, so don't think for a second that it isn't worth it.

I am making specialized tools myself at home, but it is a bit of work that requires a hand grinder and a bench grinder. i can not recommend that you all try and do the same since results depend entirely on your skill with the tools. I will put a picture up of what I made so that you can see sometime later this week if I remember. I also already know what to do and how, so I feel comfortable self-treading. All by themselves those dvds are worth the 130 bucks, quite honestly!

Once you take care of that stuff you should get a postural screening to make sure you don't have any dysfunctions that need to be corrected.

[Eddie Stelling]

Thanks alot dude! That tool looks awesome. I will definitely jump on that once I save a few bucks. Just got back from a ultrasound heat therapy followed by a tissue massage and ice treatment. My mom works for a physical therapist and got me in! It feels much better already. He said that it's not tendonitis but more of a strained/inflammed muscle that also pinged a nerve when I did the movement that caused it to start. I lost grip in my hand the moment I did it and that made him believe this. 1 wk of stretching and icing and I am supposed to be good to go. So, I guess I will use this time to work on the core and legs! Thanks for your help Slizzardman! Does this sound a about right to you as far as treatment??

[Cole Dano]

Interesting tool. where did you discover that, i thought i'd seen them all?

Not sure how good Aluminum feels, but most likely it doesn't matter.

[Joshua Naterman]

I will be getting the steel tool, personally. Like you, I have no idea how the aluminum will feel but I like the weight of steel.

The cool thing about this kind of work affects your body (to me) is that you can use it on a regular basis as a healing booster on high stress areas like the forearms and elbows. The inflammatory reaction from the rubbing boosts the healing process.

I found this by searching for "Graston Technique tools for sale" on Google. I just clicked on the first 8 links and that was one of them! How cool, right?! I thought it was ridiculous to have to go pay 3500 bucks for those tools. That's insane. I mean, the education and certification is well worth it in my opinion, but to have to pay several thousand for tools as well? Replacement sets are like 2000 bucks!!! Personally, I'll be duplicating whatever I get once I'm out of PT school in my basement shop and using the tool I linked to as well.

The tool I made is pretty crappy, I mean it works for now but I will have to make a better set... it is hard to hold apparently lol! And I can't roughen any part of it for grip because I use all edges. I never thought about using a square as the base metal but that's brilliant.

[Adriano Katkic]

Ok, 3 weeks have passed since I got tendonitis and I plan to do no upper body exercises for at least one week or more, depending on how my elbow will feel like. When my elbow is ready for exercising, should I plan a completely new SSC with easier variations than those used before injury or use easier variations for a while (few weeks?) and then skip to the harder variations? My common sense says to have a full easier variations SSC, but I want to be sure. So, what are the forum experts recommending?